Administration Of Appropriate Antibiotic Therapy Research Articles

Pseudomonas bacteremia. Retrospective analysis of 410 episodes.

We reviewed 410 episodes of Pseudomonas bacteremia occurring in patients with cancer during a ten-year period. Pseudomonas bacteremia was most common among patients with acute leukemia. The majority of patients acquired their infections in the hospital, and 51% had received antibiotic therapy for other presumed or proved infection during the preceding week. Shock occurred in 33%, and 32% had concomitant pneumonia. The overall cure rate was 62%; it was 67% for patients receiving appropriate antibiotics but only 14% for those receiving inappropriate antibiotics. A one- to two-day delay in the administration of appropriate antibiotic therapy reduced the cure rate from 74% to 46%. Patients who received an antipseudomonal beta-lactam antibiotic with or without an aminoglycoside had a significantly higher cure rate than patients who received only an aminoglycoside (72% and 71% vs 29%). Patients with shock, pneumonia, or persistent neutropenia had a substantially poorer prognosis.

Pseudomonas Bacteremia

• We reviewed 410 episodes of<i>Pseudomonas</i>bacteremia occurring in patients with cancer during a ten-year period.<i>Pseudomonas</i>bacteremia was most common among patients with acute leukemia. The majority of patients acquired their infections in the hospital, and 51% had received antibiotic therapy for other presumed or proved infection during the preceding week. Shock occurred in 33%, and 32% had concomitant pneumonia. The overall cure rate was 62%; it was 67% for patients receiving appropriate antibiotics but only 14% for those receiving inappropriate antibiotics. A one- to two-day delay in the administration of appropriate antibiotic therapy reduced the cure rate from 74% to 46%. Patients who received an antipseudomonal β-lactam antibiotic with or without an aminoglycoside had a significantly higher cure rate than patients who received only an aminoglycoside (72% and 71% vs 29%). Patients with shock, pneumonia, or persistent neutropenia had a substantially poorer prognosis. (<i>Arch Intern Med</i>1985;145:1621-1629)

Respiratory Complications of Primary Hypogammaglobulinemia

The primary hypogammaglobulinemias, with onset of acute and recurrent bacterial infections in infancy and early childhood, consist of a heterogeneous group of largely genetically determined antibody deficiency states including that congenital sex-linked form, Bruton's agammaglobulinemia. Patients with panhypogammaglobulinemia require continuous gamma globulin therapy; in spite of this, they continue to develop infections of the upper and lower respiratory tract in the form of otitis media, mastoiditis, sinusitis, rhinitis, pharyngitis, tracheobranchitis, or pneumonia of a chronic and recurrent nature. The frequency and severity of these infections vary from patient to patient. These episodes all respond to antibiotic administration, often with a prolonged course. Many patients develop permanent pulmonary sequelae in the form of atelectasis, bronchiectasis, and pulmonary fibrosis. Most of these changes involve focal areas of the lower right middle and left lingular lobes. Occasionally, the patient may develop generalized bronchiectasis but without hilar lymphadenopathy. Management emphasizes early detection, early institution of gamma globulin treatment, and administration of appropriate antibiotic therapy at the earliest onset of infection. Good pulmonary toilet, nutritional care, emotional care, and a loving home environment are of utmost importance. These patients should be followed in a medical center with the joint effort of specialists in various disciplines.