Prevention of vascular catheter-related infections.

Infection is the most common serious complication of intravascular catheters. Most cases of catheter-related infection are caused by staphylococci that originate either from the skin of the patient and migrate along the external surface of the catheter or from a contaminated catheter hub and migrate along the internal surface of the catheter. Major risk factors predisposing to catheter-related infection include prolonged duration of catheter placement, frequent manipulation of the catheter, use of thrombogenic catheter material, location of the catheter, and use of occlusive transparent plastic dressings. A number of measures have been reported in prospective, randomized clinical trials to protect against vascular catheter-related infection. This paper summarizes the clinical efficacy of various preventive measures, such as placement and maintenance of vascular catheters by a skilled infusion therapy team, institution of maximal sterile barriers, use of silver-impregnated subcutaneous cuff, antimicrobial coating of catheters with either antibiotics or antiseptics, use of an antiseptic catheter hub, application of topical disinfectants, and flushing catheters with the combination of antimicrobial and antithrombotic agents.     

Fluid resuscitation in infantile hypertrophic pyloric stenosis

The purpose of this analysis was to investigate biochemical disturbances at presentation and initial fluid resuscitation before surgery in infantile pyloric stenosis. The charts of 139 consecutive infants (113 boys and 26 girls) between 7 d and 20 wk of age with hypertrophic pyloric stenosis were reviewed. The infants were treated at the Department of Pediatric Surgery, University of Bern, Switzerland, in the period between 1987 and 1997. A trend towards hypokalaemia (13 of the 139 patients), hypochloraemia (39 patients) and especially metabolic alkalosis (98 patients) was frequently noted on admission. In 84 patients, data on fluid management and on circulating sodium, potassium, chloride and the acid-base balance immediately before surgery were also available. In these patients a significant correlation was found between the parenteral chloride dose given for fluid repair (y = 0.310 x; r = 0.54; p < 0.001) and the changes in plasma bicarbonate. The equation indicates that a chloride dose of 10 mmol/kg body weight is required to reduce plasma bicarbonate on average by 3 mmol/. CONCLUSION: Since assessment of the fluid volume stated by physical examination and history is inaccurate in infants with vomiting, the severity of metabolic alkalosis helps to define the amount of fluid required for repair.     

Inappropriate use of carbamazepine and vigabatrin in typical absence seizures

Carbamazepine and vigabatrin are contraindicated in typical absence seizures. Of 18 consecutive referrals of children with resistant typical absences only, eight were erroneously treated with carbamazepine either as monotherapy or as an add-on. Vigabatrin was also used in the treatment of two children. Frequency of absences increased in four children treated with carbamazepine and two of these developed myoclonic jerks, which resolved on withdrawal of carbamazepine. Absences were aggravated in both cases where vigabatrin was added on to concurrent treatment. Optimal control of the absences was achieved with sodium valproate, lamotrigine, or ethosuximide alone or in combination.     

Localization and quantitation of the vitamin D binding protein (Gc- globulin) in human neutrophils

Plasma-derived vitamin D binding protein (DBP) is an important physiologic regulator of the neutrophil chemotactic response to activated complement. A cell-associated form of DBP has been observed in numerous cell types. We now report that mature, circulating human neutrophils also contain cell-associated DBP. Immunofluorescence studies of normal untreated neutrophils showed the presence of DBP on the cell surface. Western blotting of detergent-soluble neutrophil lysates with a polyclonal anti-DBP showed two major immunoreactive bands, one with an apparent molecular weight of 56 Kd (identical to purified plasma-derived DBP) and a second less prominent band at 12 to 14 Kd. Quantitation of the immunoreactive bands by video densitometry indicated that normal human neutrophils contain 1.5 +/- 0.8 ng DBP/10(6) cells (n = 9). Immunoprecipitation of detergent-soluble lysates with the polyclonal anti-DBP showed only the 56-Kd form by Western blotting. In contrast, a monoclonal anti-DBP immunoprecipitated the 12 to 14 Kd form of DBP from lysates of surface-radioiodinated cells. Western blots of subcellular fractions showed that immunoreactive bands were found in the specific (secondary) granule and plasma-membrane fractions. In addition, pretreatment of neutrophils with 10 nmol/L phorbol myristate acetate (PMA) resulted in approximately a 50% reduction in the amount of DBP in both the specific granule and plasma-membrane fractions. Finally, analysis of the cell- free supernates showed that DBP was spontaneously released into the extracellular milieu: moreover, this release was enhanced if the cells were first stimulated with C5a, formyl-norleucyl-leucyl-phenylalanine (fNLP) or PMA.     

Ring sequestrum: radiographic characteristics of skeletal fixation pin- tract osteomyelitis

Major pin-tract infections are a potentially dangerous complication associated with the use of skeletal transfixation pins. The presence of a characteristic radiographic finding, the ring sequestrum, is virtually diagnostic of this abnormality. The clinical and radiographic findings in seven patients treated for this complication are presented. Thermal necrosis without infection presents as a zone of sclerosis around the tract. A narrow, radiolucent halo may surround the dense bone. When a narrow ring sequestrum is surrounded by a radiolucent halo, there is associated infection.     

Warfarin potentiation with bezafibrate

Two cases are described in which lack of awareness of the potentiation of bezafibrate on warfarin was of clinical importance.     

Clinical experience with minocycline and rifampin-impregnated central venous catheters in bone marrow transplantation recipients: efficacy and low risk of developing staphylococcal resistance.

In this retrospective evaluation of the 4-year clinical use of minocycline and rifampin-impregnated catheters in bone marrow transplantation (BMT) patients, we report low risk of development of staphylococcal resistance to the antibiotics coating the catheters and efficacy in preventing primary staphylococcal bloodstream infections.     

Dalbavancin compared with vancomycin for prevention of Staphylococcus aureus colonization of devices in vivo

OBJECTIVES: Although active against free-floating bacteria, vancomycin displays a poor activity against organisms embedded within the biofilm surrounding implanted devices. Dalbavancin is a novel glycopeptide antibiotic with strong activity against staphylococci and a long half-life that allows for once-a-week dosing. The objective of this animal study was to examine the ability of dalbavancin and vancomycin to prevent Staphylococcus aureus colonization of devices. METHODS: Twelve rabbits were randomized, in three groups of four each, to receive intravenous injections of dalbavancin, vancomycin or normal saline (control). Eight polyurethane catheter segments were subcutaneously implanted in the back of each rabbit, then inoculated with S. aureus. Rabbits were sacrificed a week later and explanted devices were cultured. RESULTS: The rates of device colonization were comparable in the vancomycin (53%) and control (47%) groups, whereas only 28% of devices in the dalbavancin group became colonized. There was a trend (although not statistically significant) toward a lower rate of device colonization following receipt of dalbavancin vs. vancomycin (P = 0.07) or saline (P = 0.02). CONCLUSIONS: The demonstrated efficacy of dalbavancin in this animal study suggest that this novel antibiotic may have an important role in the prevention and treatment of device-related infection.     

Peptide-urea interaction

The excess enthalpies of the ternary aqueous solutions containing urea and the glycyl-glycine, glycyl-L-alanine, L-alanyl-L-alanine and sarcosyl-sarcosine diketopiperazines respectively have been determined. A weak but favourable enthalpic contribution to the interaction between these solutes is found. The difference between “strong” and “weak” interactions in aqueous solutions of non-electrolytes is stressed and the role of water in the weak, non-specific interactions, is discussed. The consequence of the weakness of the urea-peptide interactions on the binding of urea to the proteins is also briefly discussed.