Hours Of Antibiotic Treatment Research Articles

Analyzing Treatment Patterns and Clinical Outcomes within the First 24 Hours of Hospitalization in Patients with Sickle Cell Disease and Infection: Evidence from a Retrospective Cohort Study

Introduction: Sickle Cell Disease (SCD) is a deadly, painful set of genetic abnormalities primarily affecting patients of African and Mediterranean descent. Although the hallmark symptom of SCD is pain, it is a multi-system disease that results in an amalgam of severe and life-threatening health consequences including increased susceptibility to bacterial, viral, and fungal infections. Infection remains the leading cause of morbidity and mortality in individuals diagnosed with SCD. We identified no research focused on the treatment patterns of antibiotic utilization in adults with SCD. This dearth of literature specific to SCD is surprising since the first 24 hours of antibiotic treatment in patients with SCD, especially those at risk for recurrent infection could reduce life threatening complications, length of hospital stay, and overall healthcare expenditures. A standardized protocol for treatment of infections in SCD does not exist and the first 24 hours of treatment varies among physicians and institutions. Treatment plans are determined by consensus guidelines, clinical experience and modifying treatment practices that have have shown promise in other diseases. The purpose of this study is to analyze treatment patterns within the first 24 hours of hospitalization in patients with SCD and infection to identify major factors influencing outcomes and clinical management. Methods: We conducted a retrospective cohort study using electronic health records from hospitalizations with a documented infection in North-Central Florida. Encounters from patients with sickle cell disease (SCD) were identified using ICD codes (ICD-9 codes: 282.41, 282.42, 282.61, 282.62, 282.63, 282.64, 282.68, 282.69). Demographics, comorbid conditions, empiric antibiotic use, causative infectious organism, and the presenting infectious syndrome were extracted from EHR for each hospitalization. Outcomes of interest were length of hospitalization and 90-day all-cause mortality. Patients with no listed comorbid conditions at the time of hospital admission were excluded. Patient characteristics and clinical factors between groups were summarized descriptively and compared between SCD encounters. Results: Among approximately 140,000 eligible encounters, 988 (0.71%) encounters were from those with SCD and of those 837 were included in the analysis: Median Age: 47 y/o Sex: Female 583 (69.7%) Male: 254 (30.3%) 209 (0.25%) had an infection fromE. coli and (12.4%) had an infection from staphylococcus aureus. 332 (39.7%) of hospital admissions were secondary to genitourinary infections Vancomycin (28.7) was the most frequently used antibiotic within the first 24 hours of admission More than half (67.4%) of patients had chronic pulmonary disease The median length of stay during our study period was 7 days 12.1% of encounters required intensive care unit hospitalization 90 Day All-Cause Mortality was 5.5% Results: We examined the key comorbid conditions and factors that influence the hospitalization and their outcomes in SCD Future studies are needed to examine the key factors resulting in an increased risk of infection among SCD genotypes and the treatment patterns within the first 24 hours of treatment in patients with SCD and non-SCD to identify major factors influencing differences in outcomes and clinical management. . Machine learning approaches could aid in stratifying patients to direct more intensive interventions towards high-risk groups to improve the health outcomes of patients with SCD

Derivation and validation of a clinical prediction model for risk-stratification of children hospitalized with severe pneumonia in Bangladesh.

Children with severe pneumonia in low- and middle-income countries (LMICs) suffer from high rates of treatment failure despite appropriate World Health Organization (WHO)-directed antibiotic treatment. Developing a clinical prediction rule for treatment failure may allow early identification of high-risk patients and timely intervention to decrease mortality. We used data from two separate studies conducted at the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) to derive and externally validate a clinical prediction rule for treatment failure of children hospitalized with severe pneumonia. The derivation dataset was from a randomized clinical trial conducted from 2018 to 2019, studying children aged 2 to 59 months hospitalized with severe pneumonia as defined by WHO. Treatment failure was defined by the persistence of danger signs at the end of 48 hours of antibiotic treatment or the appearance of any new danger signs within 24 hours of enrollment. We built a random forest model to identify the top predictors. The top six predictors were the presence of grunting, room air saturation, temperature, the presence of lower chest wall indrawing, the presence of respiratory distress, and central cyanosis. Using these six predictors, we created a parsimonious model with a discriminatory performance of 0.691, as measured by area under the receiving operating curve (AUC). We performed external validation using a temporally distinct dataset from a cohort study of 191 similarly aged children with severe acute malnutrition and pneumonia. In external validation, discriminatory performance was maintained with an improved AUC of 0.718. In conclusion, we developed and externally validated a parsimonious six-predictor model using random forest methods to predict treatment failure in young children with severe pneumonia in Bangladesh. These findings can be used to further develop and validate parsimonious and pragmatic prognostic clinical prediction rules for pediatric pneumonia, particularly in LMICs.

Therapeutics for acute otitis media

Background: Acute otitis media (AOM) is diagnosed in patients with acute onset of signs and symptoms of inflammation in the middle ear, accompanied by middle ear effusion. AOM is a common infectious disease in children, and its diagnosis and treatment can have significant impacts on the health of children.Current Concepts: The evidence-based clinical practice guidelines in Korea and other countries provide recommendations to primary care clinicians regarding the management of children with AOM. The treatment strategy for AOM depends on the patient’s age, severity of symptoms, the presence of otorrhea, and the laterality.Discussion and Conclusion: For children aged from 6-months to 2-years with unilateral non-severe AOM and children aged 2 years or older with unilateral or bilateral non-severe AOM, the published guidelines provide the option of observation rather than immediate treatment with antibiotics. High-dose amoxicillin (80 to 90 mg a day) is the firstline antibiotic for treating AOM in patients without penicillin allergies. Children in whom symptoms persist after 48 to 72 hours of antibiotic treatment should be re-examined and amoxicillin/clavulanate should be used as second-line antibiotics. Careful follow-up is required to identify the complications and sequelae of AOM, and to determine the optimum treatment.

Complicated Persistent Peritonitis

Spontaneous bacterial peritonitis (SBP) is a common complication of end-stage liver disease. SBP can present with many symptoms such as abdominal pain, fever and altered mental status.1 The diagnosis of SBP is made when ascitic fluid from a paracentesis has an absolute neutrophil count (ANC) more than 250/uL, there is a positive ascitic fluid culture, and no secondary source of infection can be idenitifed.2 However, nearly 60% of patients with SBP have negative fluid cultures.3 These patients can still potentially have SBP and should be treated as such since in-hospital mortality ranges from 20-40%.1,4 Conventional treatment for SBP includes a third-generation cephalosporin for five days, followed by lifetime prophylaxis most commonly with a fluoroquinolone. 5 After 48 hours of antibiotic treatment, a repeat paracentesis should be performed. If the ANC does not decrease by at least 25%, it is considered a therapeutic failure and the antibiotic should be changed.5 With early diagnosis and appropriate antibiotic regimen, SBP is treatable.

Duration of Administration of Antibiotic Agents for Open Fractures: Meta-Analysis of the Existing Evidence.

Surgical site infection remains a significant concern in treating patients with open fractures. In prevention of such, current guidelines support the immediate administration of antibiotic agents. The duration of antibiotic treatment is still controversial. A maximum of 72 hours, even in the absence of definitive soft tissue coverage, is recommended in a number of recent guidelines and consensus reports. The aim of this meta-analysis was to review and analyze all published literature evidence with regard to antibiotic duration in open fracture treatment. We conducted a comprehensive review of the available literature from the 1970s until the present, including five comparative (1284 open fractures) and 27 observational (5408 open fractures) studies. A subgroup analysis was further performed, based on the Gustilo type of open injury and the anatomic location of the fracture. In addition, we investigated the effect of antibiotic regimes shorter than 72 hours on infection rates. In the comparative studies, the summarized estimate of infection rate favored less than a 72-hour duration of antibiotic treatment, because prolongation of antibiotic treatment more than 72 hours did not seem to offer any protective effect against septic complications of open fractures (odds ratio: 0.85, 95% confidence interval [CI]: 0.60-1.21). The same trend was also documented in the observational studies, where the overall pooled estimate of infection rate was 10% (95% CI: 6.8%-14%) when antibiotic treatment did not exceed 72 hours and 9.2% (95% CI: 6.6%-12.2%) for more than 72 hours of antibiotic treatment (p = 0.53). In Gustilo I and II open fractures, the calculated pooled estimate of infection rate did not differ significantly when antibiotic treatment exceeded 72 hours (6%, 95% CI: 3.3%-9%) compared with shorter (up to 72 h) antibiotic protocols (4%, 95% CI: 1.8%-7%) (p = 0.52). In Gustilo III open fractures also, the calculated pooled estimate of infection rate (21.3%, 95% CI: 13%-31%) when duration of antibiotic treatment was more than 72 hours did not differ significantly compared with a shorter (less than 72 h) antibiotic treatment (17.7%, 95% CI: 12.5%-23.5%) (p = 0.39). A further subgroup analysis indicated that even shorter antibiotic regimes (24-48 h) were also equivalent to prolonged regimes of more than 72 hours in terms of infection rates. The results of the present systematic review and meta-analysis could not substantiate any benefit against septic complications of a prolonged duration of antibiotic treatment of open fractures, irrespective of their severity.

Lung inflammatory pattern and antibiotic treatment in pneumonia

BackgroundIn community-acquired pneumonia host inflammatory response against the causative microorganism is necessary for infection resolution. However an excessive response can have deleterious effects. In addition to antimicrobial effects, macrolide antibiotics are known to possess immunomodulatory properties.We aimed to evaluate inflammatory cytokine profiles – both locally (bronchoalveolar lavage) and systemically (blood) – in community-acquired pneumonia admitted patients after at least 72 hours of antibiotic treatment (with and without macrolide containing regimens) and requiring bronchoscopic examination for inadequate response due to infection progression and/or lack of clinical stability.MethodsA prospective study was performed on 52 admitted patients who developed an inadequate response after 72 hours of antibiotic treatment - non-responders community-acquired pneumonia - (blood and bronchoalveolar lavage), and two control groups: 1) community-acquired pneumonia control (blood) and 2) non-infection control (blood and bronchoalveolar lavage). Cytokine profiles (interleukin (IL)-6, IL-8, IL-10), tumour necrosis factor α and clinical outcomes were assessed.ResultsNon–responders patients treated with macrolide containing regimens showed significantly lower levels of IL-6 and TNF-α in bronchoalveolar lavage fluid and lower IL-8 and IL-10 in blood than those patients treated with non-macrolide regimens. Clinical outcomes showed that patients treated with macrolide regimens required fewer days to reach clinical stability (p < 0.01) and shorter hospitalization periods (p < 0.01).ConclusionsAfter 72 hours of antibiotic effect, patients who received macrolide containing regimens exhibited lower inflammatory cytokine levels in pulmonary and systemic compartments along with faster stabilization of infectious parameters.

Prolonged early antibiotic use and bronchopulmonary dysplasia in very low birth weight infants.

The objective of the article is to determine if > 48 hours of antibiotic treatment during the 1st week of life is associated with subsequent isolation of bacteria from the endotracheal tube (ETT), and an increased risk of bronchopulmonary dysplasia (BPD). Retrospective cohort study of very low birth weight infants. Routine weekly surveillance ETT cultures were obtained to monitor bacterial colonization in all intubated infants. Risk factors for BPD were assessed using unadjusted and multivariable analyses. In the study sample (n = 906), infants with BPD (n = 182) were more likely to have received > 48 hours antibiotic treatment (31 vs. 14%, p < 0.01) and have a resistant gram-negative bacilli in ETT (7 vs. 2%, p = 0.0001) compared with infants without BPD. Treatment with > 48 hours of antibiotics remained associated with BPD (adjusted odds ratio, 2.2; 95% confidence interval, 1.4-3.5) after controlling for confounding variables. Antibiotic duration > 48 hours in the 1st week of life was associated with subsequent BPD and the presence of resistant bacteria in routine ETT cultures.

Traumatic acute lymphangitis in the upper extremity, case report

Introduction: Lymphangitis is an inflammatory condition associated with a damage of the lymph wall, emerging due to various etiologies, such as bacterial or fungal infections, photodermatitis, malignities and bug bites. In this brief report, we aimed to emphasize the importance of this diagnosis in acute settings of hand surgery. Materials and Methods: Findings of upper extremity lymphangitis were typically identified in 7 patients who were presented to our emergency hand surgery clinic from September 2011 to December 2012. All of the patients had a preceding hand trauma. Results: All of the patients received empirical antibiotic treatment following routine sampling of blood and wound tissue cultures. Treatment was modified by an infectious disease specialist according to the etiology and identified microbiological agent. There was a dramatic improvement in all patients after 48 hours of antibiotic treatment. Conclusion: In emergency hand surgery practice, usually surgeons concentrate on the area of trauma and focus on proper tissue repair. However, it should be kept in mind that traumatic injuries where tissue integrity is lost lay the grounds for a bacterial lymphangitis. In such cases, it is utmost important to immediately initiate the empirical antibiotic treatment.

Deep Neck Abscesses in Children and Adolescents: 10 Year Experience in Two General Hospitals

Purpose : The purpose of this study was to review our recent experiences with deep neck abscesses in children and adolescents and to provide helpful information in treatment and diagnosis by comparing them with those in other available literatures. Methods : Medical records of 36 children and adolescents admitted for deep neck abscess at two hospitals from January 2000 to October 2010 were reviewed retrospectively. Results : Male to female ratio was 1.4 : 1 and the mean age was 6.5 years. Painful neck swelling and fever were the most frequent symptoms in patients under thirteen years of age whereas trismus and headache were frequent symptoms in patients over fourteen years of age. Submandibular space was the most common site of deep neck abscess in patients under thirteen years of age, whereas peritonsillar space was the most common site in patients over fourteen years of age. The results of bacterial cultures were positive in 61.5% of drained cases. Staphylococcus aureus was the most commonly identified bacteria in 6 patients (37.5%) and 5 of them were under 2 years of age. Twenty six patients received surgical drainage while the others were treated with antibiotics only. There were no statistically significant differences in the durations of admission, fever after admission, and antibiotic treatment between surgical and medical treatment groups. Conclusion : The common sites of deep neck abscess, associated symptoms, and causative organisms were different between children and adolescents. As there were no differences in durations of admission, fever, or antibiotics treatments between surgical and medical treatment groups, surgical drainage may be avoided by early recognition and suspicion. However, if there is no improvement of symptoms or size of abscesses within 48-72 hours of antibiotic treatment, surgical drainage should be considered.

Population Pharmacokinetic Modeling and Optimal Sampling Strategy for Bayesian Estimation of Amikacin Exposure in Critically Ill Septic Patients

Because the sepsis-induced pharmacokinetic (PK) modifications need to be considered in aminoglycoside dosing, the present study aimed to develop a population PK model for amikacin (AMK) in severe sepsis and to subsequently propose an optimal sampling strategy suitable for Bayesian estimation of the drug PK parameters. Concentration-time profiles for AMK were obtained from 88 critically ill septic patients during the first 24 hours of antibiotic treatment. The population PK model was developed using a nonlinear mixed effects modeling approach. Covariate analysis included demographic data, pathophysiological characteristics, and comedication. Optimal sampling times were selected based on a robust Bayesian design criterion. Taking into account clinical constraints, a two-point sampling approach was investigated. A two-compartment model with first-order elimination best fitted the AMK concentrations. Population PK estimates were 19.2 and 9.34 L for the central and peripheral volume of distribution and 4.31 and 2.21 L/h for the intercompartmental and total body clearance. Creatinine clearance estimated using the Cockcroft-Gault equation was retained in the final model. The two optimal sampling times were 1 hour and 6 hours after onset of the drug infusion. Predictive performance of individual Bayes estimates computed using the proposed optimal sampling strategy was reported: mean prediction errors were less than 5% and root mean square errors were less than 30%. The present study confirmed the significant influence of the creatinine clearance on the PK disposition of AMK during the first hours of treatment in critically ill septic patients. Based on the population estimates, an optimal sampling strategy suitable for Bayesian estimation of the drug PK parameters was developed, meeting the need of clinical practice.

Epidemiology of bloodstream infection associated with parenteral nutrition

Catheter-related bloodstream infections (CR-BSIs) occur in 1.3% to 26.2% of patients with central venous catheters used to administer parenteral nutrition (PN). Because of their nutritional components, PN solutions can support microbial growth. Contamination during preparation and handling is rare in hospitals and home-infusion pharmacies but may be difficult to control in a home setting. The risk of infection is increased in hospitalized patients because of malnutrition-associated immunosuppression, hyperglycemia exacerbated by dextrose infusion, microbial colonization/contamination of catheter hubs and the skin surrounding insertion site, and poor nursing care. During long-term catheter use for PN, an intraluminal biofilm, catheter-tip fibrin sheath or tail, or central venous thrombosis creates sites for microbial seeding and infection. Chronic conditions and psychosocial issues also increase the risk of infection. In hospitalized patients with BSIs, the most common organisms are coagulase-negative staphylococcus, Staphylococcus aureus, Enterococcus, Candida spp, Klebsiella pneumoniae, and Pseudomonas aeruginosa. In the long-term PN population, approximately 60% of CR-BSIs are caused by coagulase-negative Staphylococcus. The best plan of care for a suspected or known infected catheter in a hospitalized patient is to reinsert a new central line after 48 hours of antibiotic treatment and negative blood cultures. In patients who receive long-term PN, hospitalization increases the risk of a nosocomial infection because the catheter can be contaminated by staff. A patient with fungemia must always be admitted and catheter removed. With gram-positive and gram-negative organisms, the catheter may not need to be removed. In most patients receiving PN at home, removing a long-term venous-access device is challenging. Peripheral vein access or peripherally inserted central catheters are needed until a new permanent device can be inserted after negative blood cultures are obtained. Evaluation of remote site infection also is necessary. Strategies to reduce or prevent infection include catheter lock therapy, daily evaluation of continued need for PN, enteral rather than PN support, and avoiding overfeeding. More studies are needed to demonstrate conclusively the benefits of immunonutrition, such as the use of omega-3 or glutamine supplements to reduce CR-BSIs in patients receiving PN.

Once-a-day Amoxicillin Therapy of Streptococcal Pharyngitis: Good, Better and, Future, Best?

Source: Clegg HW, Ryan AG, Dallas SD, et al. Treatment of streptococcal pharyngitis with once-daily compared with twice-daily amoxicillin. Pediatr Infect Dis J. 2006;25:761–767; doi:10.1097/01.inf.0000235678.46805.92Investigators from several Charlotte, NC institutions and the University of Minnesota, Minneapolis conducted a prospective, randomized, blinded, non-inferiority trial comparing once-daily (1xd) with twice-daily (2xd) amoxicillin for the treatment of group A ß-hemolytic streptococcal (GABHS) pharyngitis. Patients with a positive rapid GABHS test were stratified by weight and then randomly assigned to receive either 1xd amoxicillin (750 mg if <40 kg, 1000mg if ≥40 mg) or 2xd amoxicillin (375 mg 2xd if <40 kg, 500 mg 2xd if ≥40 mg) for 10 days. Of 652 patients enrolled and randomized, 590 (90%) were evaluable: 294 in the 1xd and 296 in the 2xd group. Of the 62 patients not evaluated, 45 were excluded because they did not follow up, 11 for negative cultures following a positive rapid streptococcal test, 3 because they did not take medication, and 3 who were enrolled twice and only had their first enrollment included.At visit 2 (14 to 21 days post-therapy), bacteriologic failure rates were similar between the 1xd treatment group (20.1%) and the 2xd group (15.5%, difference non-significant). The clinical recurrence rate was also comparable for the 2 treatment groups at visit 2 (9.2% 1xd vs 7.1% 2xd). At visit 3 (28 to 35 days post-therapy) the bacteriologic failure rate was significantly higher in the 2xd group (7.1% vs 2.8%). There were no significant differences in adverse events between the 2 treatment groups (gastrointestinal symptoms being most common). This study, along with previous studies,1,2 shows that 1xd amoxicillin is not inferior to 2xd amoxicillin for the treatment of GABHS pharyngitis despite the failure rate observed.Dr. Rathore has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The purpose of antimicrobial therapy for GABHS pharyngitis is both for the treatment of the acute illness and for prevention of non-suppurative post-streptococcal complications.3 Dependable rapid diagnosis has made immediate treatment of GABHS pharyngitis easier, but adherence to the antibiotic regimen may be problematic. Treatment with injectable depot penicillin is the best option to assure adherence and the only one shown to decrease non-suppurative complications of GABHS pharyngitis.4 However, the intramuscular route is frequently not acceptable to patients, parents, or physicians. Oral treatment regimens for GABHS pharyngitis have improved with time. Over the years we have decreased the frequency of daily antibiotic administration from 4 times a day to twice a day for treatment of GABHS pharyngitis.5Our ability to generalize the results of this study is limited because the patients were overwhelmingly white. Despite this limitation, the findings of this preliminary study will be welcome news for many pediatricians and parents. The next steps will be to replicate the study in other population groups and then go on to test the dogma that 10 days of antibiotic therapy are necessary for treatment of GABHS. Previous investigations have shown that the pharynx is sterile within 24 hours of antibiotic treatment for GABHS pharyngitis.6 It may be that a 5- or 7-day treatment course, or perhaps an even shorter one, would be just as effective as a 10-day course. While 1xd amoxicillin should increase adherence to treatment, a shorter course of therapy, if effective, would improve adherence even more, and a single oral dose would be best of all.

Levels of Basic Fibroblast Growth Factor (bFGF) and Transforming Growth Factor-betal (TGF-β1) in Cerebrospinal Fluid (CSF) and the Severity of Bacterial Meningitis in Children † 1732

This study was performed to test the hypothesis that the levels of neurotrophic growth factors, bFGF and TGF-βlin CSF are increased in children with bacterial meningitis, and also related with their outcome. The levels of bFGF and TGF-β1 were measured by a sandwich enzyme immunoassay in children aged below 15 years, with bacterial meningitis (BM) (n=18), aseptic meningitis (AM) (n=12), encephalitis (EN) (n=8), and control (CN) children (n=18). At a mean duration of follow-up of 17 months was performed to determine their neurodevelopmental sequelae. Both CSF bFGF and TGF-β1 were significantly higher in children with BM than those with AM, EN, or CN. There was no significant difference in CSF bFGF or TGF-β1 between patients with AM, EN and CN. Except for two patients with acute fatality, the CSF bFGF decreased significantly after 24-48 hours of antibiotic treatment(p<0.0005) in patients with BM. All 3 patients who had CSF bFGF above 20 pg/ml, died. Patients of BM with major sequelae had significantly higher levels of CSF bFGF than those without (p<0.05); this difference between the groups was not seen in TGF-β1. Our results demonstrated that CSF bFGF and TGF-β1 are elevated during acute bacterial meningitis, and bFGF is associated with the severity of the disease, especially fatality. The production and release of neurotrophic factors appear to play an important role in the pathophysiology of bacterial meningitis in children.Table

Early discontinuation of antibiotic treatment in newborns admitted to rule out sepsis: a decision rule.

We developed a decision rule to define a group of newborns eligible for discontinuation of antibiotic treatment 24 hours after initiation. The decision rule is based on two clinical assessments, three demographic variables, four maternal risk factors and six laboratory studies. The rule was created by retrospective analysis of all admissions to rule out sepsis at 10 Kaiser Permanente Northern California Region nurseries during a 2-month period in 1990. Of the 214 study subjects, 11 (5%) had a positive bacterial or viral culture result. No deaths occurred, but three babies who had negative culture results experienced late deterioration (after 24 hours in the special care nursery). After 24 hours of antibiotic treatment, 133 (67%) of the 199 babies who had negative culture results were asymptomatic, 36 (18%) had clear signs of illness and 30 (15%) had questionable signs of illness. The rule correctly identified all babies with positive culture results as well as all persistently symptomatic babies with negative culture results. The rule also identified 57 low-risk babies eligible for only 24 hours of antibiotic treatment. We tested the rule on a second data set. The rule identified 19 of 20 newborns with positive culture results in this independent group. The 20th baby was not identified because a required test (complete blood count at 12 to 24 hours of age) was not done. Under controlled clinical conditions, this baby could have returned to the nursery to complete antibiotic treatment. We concluded that early discontinuation of antibiotic treatment in selected newborns is safe and could lead to a 1 to 2% decrease in special care nursery days in our 10 hospitals.

High Levels of Tumor Necrosis Factor- and Interleukin-6 in the Ascitic Fluid of Cirrhotic Patients with Spontaneous Bacterial Peritonitis

We prospectively measured the concentrations of immunoreactive tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), and interleukin-6 (IL-6) in the serum and ascitic fluid of 14 alcoholic cirrhotic patients with spontaneous bacterial peritonitis (SBP) and 16 alcoholic cirrhotic patients with sterile ascitic fluid. TNF-alpha levels in ascitic fluid were significantly higher for the patients with SBP: 399.57 +/- 129.23 pg/mL vs. 35.76 +/- 5.57 pg/mL (P < .001). IL-6 levels in ascitic fluid were also significantly higher for the patients with SBP: 170,713 +/- 57,109 ng/mL vs. 5,414 +/- 973 ng/mL (P < .001). By contrast, serum levels of TNF-alpha and IL-6 were just slightly more elevated than normal values. The concentration of IL-1 in the ascitic fluid of all patients was elevated, but there was no difference between patients with SBP or sterile ascites in this respect. In the patients with SBP, levels of TNF-alpha and IL-6 in ascitic fluid decreased during the first 48 hours of antibiotic treatment. Our results suggest that measurements of TNF-alpha and IL-6 in ascitic fluid may become useful markers both for the diagnosis of SBP and for monitoring the treatment of cirrhotic patients.

Attempts to ControlFlexibacter columnarisEpizootics in Pond-Reared Channel Catfish by Vaccination

Evaluation of bacterins for the immunization of channel catfish Ictalurus punctatus against Flexibacter columnaris was carried out over 5 years. Groups of 60,000–100,000 pondreared channel catfish, weighing an average of 1.5–4.1 g, were vaccinated each year with formalininactivated Flexibacter columnaris bacterins by immersion. Bacterins were prepared from isolates of the preceding year's epizootic. Equal numbers of nonvaccinated channel catfish reared under similar conditions served as controls. Fish were vaccinated during May each year when water temperatures ranged from 16 to 18°C. Data were recorded daily from early June through midSeptember as water temperatures rose to 24–26°C. Deaths were recorded daily, and the number of hours required for antibiotic treatments were monitored. Analysis of the data indicated a general trend toward a beneficial effect of vaccination, particularly for larger fish. Mortality and hours of antibiotic treatment were significantly higher for most control groups than for vaccinated groups.

Kill kinetics of the cephalosporin antibiotics cephalexin and cefuroxime against bacteria of veterinary importance.

Kill kinetic studies for two cephalosporin antibiotics, cephalexin and cefuroxime were carried out against veterinary strains of Escherichia coli, Pasteurella multocida, Streptococcus suis, Erysipelothrix rhusiopathiae and a laboratory culture of Staphylococcus aureus. In more than 90 per cent of cases a kill of more than 99 per cent was achieved within four hours of antibiotic treatment at concentrations of 2 or 4 micrograms/ml. Although cefuroxime was effective at lower concentrations than cephalexin the rates of kill of the two antibiotics were comparable. The results are discussed in relation to in vivo dosage regimens.