Piperacillin in surgical infections: a clinical trial

Prophylaxis against sepsis in patients undergoing major surgery

Postoperative infection in general surgical patients is discussed according to operation types. A selection of the huge literature on each group is reviewed, and details from the author's own work and ideas are presented. By discussing these points attempts are made to determine the best regimens for a given set of clinical circumstances. There is a small literature indicating that postoperative chest infection can be prevented by some antibacterial drug regimens, and this question has been addressed; it seems that in the past it has been largely ignored. Some nonantibacterial methods of reducing postoperative infection are also briefly discussed.

Associated mortality and clinical characteristics of nosocomial Pseudomonas maltophilia in a university hospital

We studied the spectrum of clinical disease in 99 patients with nosocomial Pseudomonas maltophilia isolates at the University of Virginia Hospital from 1981 through 1984. The annual rate of isolation increased from 7.1 to 14.1 per 10,000 patient discharges. A crude mortality rate of 43% was documented in all patients from whom the organism was cultured, and the data include 12 patients with nosocomial bacteremia (four deaths). Risk factors associated with death for patients having a P. maltophilia isolate included the following: requirement for care in any intensive care unit during hospitalization (P = 0.0001), patient age over 40 years (P = 0.002), and a pulmonary source for the P. maltophilia isolate (P = 0.003). All P. maltophilia isolates were susceptible to trimethoprim-sulfamethoxazole, 60% of the isolates were resistant to all aminoglycosides (amikacin, tobramycin, and gentamicin), and more than 75% of the isolates were resistant to all beta-lactam antibiotics. The antibiotic susceptibility pattern allows for a niche exploitable in the hospital microbial environment by an organism with a marked associated mortality.