Total hip arthroplasty (THA) causes acute blood loss. It may lead to a deficiency in coagulation factors, which, in turn, may lead to increased bleeding during the postoperative period.
Antimicrobial therapy of severe infections in critically ill patients becomes an important clinical problem. One of the reason is increasing resistance of pathogens to antibiotics. In this paper the current problems of the treatment of severe infections in Intensive Care Units' patients were discussed as well as benefits of modern antimicrobial agents were presented.
Background. Infections in critically ill patients are the main reasons for a lack of therapeutic success and increased mortality in intensive care units (ICUs). There have been many analyses of the incidence of infections in ICUs; however, no large studies of this kind have been conducted either in Poland or in Eastern and Central Europe.Objectives. The aim of the research was to undertake a one-day study of the prevalence of infections in ICUs in Warszawa and the Mazovian region of Poland.Material and Methods. A prospective questionnaire survey analysis − a one-day prevalence study of infections − was carried out on June 25, 2014, in 28 ICUs in Poland.Results. Among 205 ICU patients (193 adults and 12 children), 134 infections were found in 101 patients (99/193 adults (51.30%) and 2/12 children (16.70%)), and bacterial colonization in 19/205 (9.3%) patients. In 66.42% of the cases, more than 1 site of infection was diagnosed. On the day of the study, 75.40% of the diagnosed infections had positive microbiological results. The most frequent were respiratory tract infections (53.73%), wound infections (18.65%) and bloodstream infections (14.92%). Most of the infections (64.10%) were caused by Gram-negative bacteria (GN), followed by Gram-positive bacteria (GP; 31.80%) and fungi (4.10%). The most frequently reported GN microorganisms were Enterobacteriaceae (44.7%). Methicillin-resistant Staphylococcus aureus (MRSA) infections were found in 8.80% of the patients. Antibiotics were administered to 75.60% of the adult patients, in 69.20% as targeted treatment. Mechanical ventilation, central vein catheterization and urinary bladder catheterization were used in 67.80%, 85.85% and 94.63% of the patients, respectively.Conclusion. On the day of the study, more than half of the patients had infections, mostly from GN bacteria. Respiratory tract infections were the main type found. In about 2/3 of the patients, antibiotics were administered, mainly as targeted therapy.
The members of the bacterial Enterobacteriaceae family play an important role in the aetiology of many hospital infections. Some of them are able to produce β-lactamase, an enzyme which induces the resistance of those bacteria to penicillins, cephalosporins and, in severe infections, to penicillins with β-lactamase inhibitors. In this situation, the carbapenems become the drugs of choice. The objective of this study was to analyse the in vitro efficacy of three carbapenems: ertapenem, imipenem and meropenem against bacterial species of the Enterobacteriaceae family.A total of 99 bacterial species (including ten bacterial species producing the ESBL mechanism), isolated between September 2011 and March 2012 from diagnostic material collected from patients of surgical clinics in the department of motoskeletal system infections and the critical care unit, hospitalised in the Military Institute of Medicine in Warsaw, were analysed. The values of MIC 50 and MIC 90 were recorded.All isolated bacterial species were susceptible to meropenem. One strain of Morganella morganii was resistant to imipenem, while one strain of Enterobacter cloaceae and one strain of Klebsiella pneumoniae were resistant to ertapenem. In the Enterobacteriaceae ESBL(-) group, the values of MIC 50 were 0.006 μg mL-1 for ertapenem, 0.19 μg mL⁻¹ for imipenem, and 0.032 μg mL⁻¹ for meropenem, and the MIC 90 values were: 0.25 μg mL⁻¹, 0.5 μg mL⁻¹ and 0.125 μg mL⁻¹, respectively. In the Enterobacteriaceae ESBL(+) group, the values of MIC 50 were 0.38 μg mL⁻¹, 0.25 μg mL⁻¹, 0.064 μg mL⁻¹, and the values of MIC 90 were 0.5 μg mL⁻¹, 0.25 μg mL⁻¹ and 0.125 μg mL⁻¹, respectively.All analysed carbapenems had high in vitro efficacy against both Enterobacteriaceae ESBL(-) and Enterobacteriaceae ESBL(+) bacterial species.
A 33 year old man with recurrent respiratory tract infections was admitted to surgery ward. During esophagoscopy and bronchoscopy--esophago-tracheal fistula was found. Diagnosis was confirmed by radiologic examination of esophagus. Surgical treatment was performed with good result.
Purpose . Postoperative urinary retention (POUR) increases the duration of hospitalization and frequency and risk of urinary bladder catheterization. The objective of this study was to analyze the efficacy of intramuscularly administered drotaverine hydrochloride in the prevention of POUR in orthopedic patients. Methods . Two hundred and thirty patients 17–40 years of age undergoing lower limb orthopedic procedures under spinal anesthesia were enrolled in the study. The study group received 40 mg of drotaverine hydrochloride intramuscularly; the second group was the control. The main outcome measure was (1) the time to micturition and (2) the incidence of urinary bladder catheterization and time to catheterization. Results . Two hundred and one patients of 230 enrolled participants completed the study. Compared to the control group, the male patients in study group exhibited a shorter time to spontaneous micturition (441 versus 563 minutes, 95% CI of the difference of means between 39 and 205 minutes) and a lower incidence of urinary bladder catheterization (4/75 versus 10/54) (RR 0.29, 95% CI: 0.1–0.87;P=0.0175). Conclusions . Intramuscular administration of drotaverine hydrochloride decreased the time to spontaneous micturition and decreased the incidence of urinary bladder catheterization in male patients who underwent orthopedic surgery under spinal anesthesia. This trial is registered with NCT02026427 .
