Bacterial Endocarditis In Patients Research Articles

Efficacy of Penicillin Prophylaxis

In Reply.— Studies evaluating the efficacy of antibiotic prophylaxis for bacterial endocarditis in patients undergoing dental extractions are numerous, but studies dealing with the association between the peak serum concentrations achieved by the antibiotic used and the occurrence of postextraction bacteremia are lacking. It is questionable whether higher dosages than the dosages used in our study would have prevented the occurrence of postextraction bacteremia, because no relationship was found betwen the occurrence of postextraction bacteremia and postextraction serum penicillin concentrations.

Risk of bacteremia after endotracheal intubation for general anesthesia.

Blood cultures were obtained before and after endotracheal intubation to assess the risk of bacteremia associated with this procedure and to evaluate the need for prophylactic antibiotics to prevent bacterial endocarditis in patients with structural heart disease requiring general anesthesia. Blood cultures were obtained immediately before intubation and two and ten minutes after intubation in 50 individuals without evidence of structural heart disease who required general anesthesia for elective surgery. Of 32 who had orotracheal intubation, only one demonstrated postintubation bacteremia; of 18 individuals who had nasotracheal intubation, none had evidence of bacteremia. These data suggest that in healthy individuals undergoing endotracheal intubation under direct vision the risk of bacteremia is quite small (about 2%).

Cardiovascular Diseases: An Annotated Bibliography of Recent Literature

Cardiovascular Diseases: An Annotated Bibliography of Recent Literature

Vancomycin Revisited

Vancomycin, virtually discarded after development of antistaphylococcal penicillins, has recently been receiving renewed attention. There are several clinical situations in which it appears to offer advantages over other available antimicrobial agents: infections due to methicillin-resistant staphylococci; bacterial endocarditis in patients allergic to penicillin; staphylococcal enterocolitis; staphylococcal infection in patients undergoing hemodialysis; infections caused by penicillin-resistant diphtheroids; and prophylaxis of bacterial endocarditis in patients with prosthetic valves or penicillin allergy. Its penetration into the cerebrospinal fluid suggests that vancomycin may be useful in treating certain infections of the central nervous system. Although its ototoxic and nephrotoxic potential cannot be ignored, these problems can be minimized by keeping the serum concentration at the proper level.

Transient Bacteremia Associated With Nasotracheal Suctioning

TRANSIENT bacteremia following dental manipulation,¹genitourinary instrumentation,²sigmoidoscopy,³bronchoscopy,⁴barium enema,⁵percutaneous liver biopsy,⁶tonsillectomy, and massage of such loci as infected boils and carbuncles⁷may produce bacterial endocarditis in patients with congenital or rheumatic heart disease. On the basis of these findings, the American Heart Association has recommended antimicrobial chemoprophylaxis for patients with cardiovascular abnormalities undergoing these procedures. This communication reports a prospective study showing that transient bacteremia with definable characteristics may follow nasotracheal suctioning (NTS). <h3>Methods</h3><h3>Subjects.—</h3> Sixty-eight patients hospitalized for various reasons at the West Virginia University Medical Center intensive care unit (ICU) underwent NTS as ordered by their attending physicians. Thirty healthy medical students served as controls. The design and intent of the study was explained to each patient or member of the family. <h3>Culture Studies.—</h3> All subjects had nasopharyngeal cultures taken before they underwent NTS. The cultures were

Treatment of bacterial endocarditis in patients with penicillin hypersensitivity.

Excerpt A major problem in present-day management of bacterial endocarditis is the choice of optimal antibiotic therapy in patients who give a history of allergy to penicillin. Bacterial endocardit...

Bacterial endocarditis, pericarditis and cardiac tamponade ∗

A case is reported of subacute bacterial endocarditis complicated by massive hemorrhagic pericardial effusion, cardiac tamponade and death. This rare clinical event, to our knowledge, has not been reported heretofore. The advent of antimicrobial therapy has profoundly affected the natural history of bacterial endocarditis in patients so treated. Alteration in this natural history has been expressed in changing character of complications of the endocarditis. An infectious type of pericarditis with effusion may be a more common complication of the disease now than formerly was the case. Realization that such a complication does occur may result in avoidance of needless diagnostic confusion and early institution of appropriate therapeutic efforts.

Treatment of Bacterial Endocarditis in Patients with Penicillin Hypersensitivity.

s1 May 1966Treatment of Bacterial Endocarditis in Patients with Penicillin Hypersensitivity.George R. Green, M.D., Gustavus A. Peters, M.D., F.A.C.P., Joseph E. Geraci, M.D., F.A.C.P.George R. Green, M.D.Search for more papers by this author, Gustavus A. Peters, M.D., F.A.C.P.Search for more papers by this author, Joseph E. Geraci, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-64-5-1170_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptSeventy-one of 400 patients treated for bacterial endocarditis (1951 through 1964) had a history of penicillin allergy (18%). Allergic reactions occurred in 22 of 56 such patients receiving penicillin (39%); 18 patients without allergic history had reactions to penicillin (5%). No reaction was fatal, but one patient had an anaphylactic reaction. In 5 of 22 patients in the allergic group and in 5 of 18 in the nonallergic group, penicillin therapy was discontinued because of severe reactions but was successfully completed in the others, the delayed allergic reaction being controlled by steroids or antihistamines or both. Little correlation was noted... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Rochester, Minnesota PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1966Volume 64, Issue 5Page: 1170-1170KeywordsAllergy and immunologyAnaphylaxisAntihistaminesEndocarditisHypersensitivityPenicillinSteroids Issue Published: 1 May 1966 PDF downloadLoading ...

CURRENT THERAPY: The Selection of an Antibiotic for the Treatment of Bacterial Endocarditis

Prior to the advent of potent bacteriostatic and bacteriocidal agents, it was common practice to subdivide cases of bacterial endocarditis into two groups: acvte bacterial endocarditis, i.e. bacterial endocarditis of less than the three or four weeks’ duration, and subacute bacterial endocarditis, which persisted for more than four weeks. The discovery and utilization of present-day antibiotics have changed the entire picture and course of bacterial invasion of the endocardium and made the distinction meaningless. Preferably, in classification emphasis should be placed on the specific organism responsible for the bacterial invasion and, where known, the name of the organism should be made a part of the disease designation. Some bacteria prove relatively resistant to penicillin; others actually produce a specific penicillin-destroying enzyme known as penicillinase. Bacteria which are resistant to penicillin are in some cases susceptible to large doses of the antibiotic. Bacteria which are penicillin-resistant but with individual cells sensitive to the action of the antibiotic form an important group: their sensitivity, as measured in the laboratory, may vary 1,000-fold or more according to the inoculum. Whether or not such organisms will be affected by large doses of penicillin would, therefore, seem to depend more on heaviness of infection than on resistance of the organism as determined by laboratory tests. Although the organism most commonly responsible for bacterial endocarditis in patients with rheumatic valvular disease or congenital lesions of the heart and vessels is Str. viridans, this organism poses little problem in therapy because-along with pneumoccoci, gonococci and group A hemolytic streptococci-strains of Str. viridans all are moderately or highly susceptible to penicillin therapy. Enterococci, which are relatively resistant to penicillin alone, now account for about 15 per cent of cases, contrasted with 4 or 5 per cent in the pre-antibiotic era. Endocarditis due to enterococci or coliform organisms occurs most frequently in patients with infections of the genitourinary or the intestinal tract or after various diagnostic or therapeutic procedures carried out in these areas. Most stubborn, chronic cases of bacterial endocarditis today are caused by staphylococci. Infection with staphylococci produces hypersensitivity toward these organisms: although the patient builds up a fair degree of immunity toward further overwhelming invasions of micrococci, paradoxically he responds with definite lesions to amounts of exotoxin so minute they would pass unnoticed in ordinary persons. Staphylococci have been