Morbidity associated with long-term use of totally implantable ports in patients with AIDS.
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To determine the morbidity associated with long-term use of a totally implantable central venous access device (Port-A-Cath [PAC]) in patients with AIDS, we studied 68 consecutive patients with AIDS requiring 79 such devices for long-term use, inserted over a period of 5 years. The total number of PAC-days was 20,159. At least one PAC-related complication occurred with 40 of 79 PACs (50.6% [95% confidence interval (CI): 39.6%-61.6%]), and 16 devices (20.2% [95% CI, 11.4%-29.0%]) had to be removed because of complications. Device-related infection occurred with 33 of 79 PACs (41.7% [95 CI, 30.8%-52.6%]). The predominant infection occurring with PACs was chamber infection, with an incidence of 0.16 per 100 PAC-days. The predominant organisms isolated from patients with chamber infections but also from those with device-related bacteremia were gram-positive cocci (79.4%). The presence of neutropenia (odds ratio [OR] = 9.72; 95% CI, 3.0-31.3; P < .001) and a CD4 cell count lower than 0.025 x 10(9)/L (OR = 6.14; 95% CI, 1.9-19.2; P = .002) were independent predictors of infection. The antibiotic lock technique was associated with decreased device loss when compared with isolated systemic antibiotic therapy (OR = 0.05; 95% CI, 0.0-0.59; P = .008). This technique may be useful to treat PAC infection in patients with AIDS, for whom the risk of PAC-related complications is very high. (+info)
BACKGROUND: The use of peripheral intravenous nutrition (PIN) has been growing in recent years due to the increase in awareness of the pathophysiological mechanisms of peripheral vein thrombophlebitis, as well as the availability of techniques to prevent or retard its onset. With the increase in public and medical practitioner awareness of the importance of nutritional interventions in health and disease, more outpatient-based PIN therapy is being performed. Outpatient, office-based PIN has unique features including high osmolality, high infusion rates, and short infusion duration. METHODS: Previous intravenous nutrition studies were used to estimate safety parameters for outpatient, office-based PIN. CONCLUSIONS: Osmolalities of the infusion can approach 1000 mOsm/L if the duration of the infusion is only several hours. The infusion should be diluted to reduce the osmolality, even if an increase in infusion rate is necessary. Duration of infusion should be less than three hours to reduce the time the irritating mixture contacts the vein wall. This requires high (150 - 330 mL/hour) infusion rates. The largest vein, and smallest and shortest catheter possible to achieve the infusion rate desired should be used, with in-line filtration of at least 0.45mm. The cannula should be removed at the first sign of pain or redness. Standard procedures to reduce infection risks should be followed. (+info)
The efficacy of continuous infusion flucloxacillin in home therapy for serious staphylococcal infections and cellulitis.
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The efficacy and safety of continuous infusion flucloxacillin as home-based treatment was assessed in 62 consecutive patients with proven serious methicillin-susceptible Staphylococcus aureus (MSSA) infections (n = 36) and cellulitis (n = 26). The treatment was well tolerated and resulted in cure or adequate suppression of infection in 27 of 28 (96%) patients in the serious MSSA infection group, and in 24 of 26 (92%) patients in the cellulitis group. (+info)
Catheter-related bacteremia due to Streptomyces in a patient receiving holistic infusions.
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Streptomyces species are rare causes of invasive infection in humans. We report the first documented case of a catheter-associated bacteremia due to Streptomyces. The most likely source of infection was unlicensed, injectable holistic preparations that the patient had received. We review reported cases of invasive infections caused by Streptomyces and comment on the potential infectious complications of parenteral holistic treatments. (+info)
Prospective randomized trial of lisuride infusion versus oral levodopa in patients with Parkinson's disease.
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Motor complications are a major source of disability for patients with advanced Parkinson's disease. Surgical therapies provide benefit to some, but these treatments are expensive and associated with adverse effects. Current research indicates that motor complications are associated with abnormal, intermittent, pulsatile stimulation of denervated dopamine receptors using short acting dopaminergic agents such as levodopa. Retrospective studies suggest that the use of longer-acting more continuous dopaminergic therapies can improve both motor fluctuations and dyskinesia. We performed a prospective, long-term (4-year) trial comparing patients randomized to receive subcutaneous infusion of the dopamine agonist lisuride versus conventional therapy with oral levodopa and dopamine agonists. We demonstrate that patients receiving lisuride infusions experienced a significant reduction in both motor fluctuations and dyskinesia compared with patients receiving standard dopaminergic therapies. Benefits persisted for the 4-year duration of the study. Mean Unified Parkinson's Disease Rating Scale scores in "ON" and "OFF" states did not significantly change between baseline and 4 years for patients in the lisuride group, but deteriorated in patients in the levodopa group. This study indicates that continuous lisuride infusion can be beneficial for patients with advanced Parkinson's disease and reverse established motor fluctuations and dyskinesia. (+info)
Free and total cefazolin plasma and interstitial fluid concentrations at steady state during continuous infusion.
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Free and total concentrations of cefazolin were compared in plasma and interstitial fluid during continuous intravenous infusion therapy. Seven patients, median age 53 (25-74) years, were administered a constant infusion of cefazolin at a mean (+/-S.D.) dose of 3.5 g (+/-1.1) per 24 h for > or = 5 days. Four blisters were induced on the forearm of each patient for sampling of interstitial fluid. Free concentrations in plasma and interstitial fluid were similar, and correlated better than total concentrations (r(2) = 0.82, P = 0.005 versus r(2) = 0.54, P = 0.056). In all patients, the free concentrations in the interstitial fluid were at least two-fold the MIC(90) for Staphylococcus aureus. (+info)
Stability of benzylpenicillin during continuous home intravenous therapy.
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OBJECTIVES: The aim of this study was to investigate the temperature profile of home intravenous (iv) antibiotic reservoirs and the stability of 16 megaunits of benzylpenicillin sodium in 120 mL of sodium chloride 0.9% at constant and variable temperatures. METHODS: A Tinytag computerized thermometer recorded temperatures every minute in the home iv antibiotic reservoir pouches of nine patients over a 24 h period. Similar bags containing benzylpenicillin sodium (16 megaunits) were maintained either at a constant 36 degrees C, 26 degrees C or 21-22 degrees C or were worn in a pouch by five healthy volunteers for a 24 h period. Other bags were stored at 3-5 degrees C for 10 days. The bags were sampled at timed intervals and benzylpenicillin concentrations assayed by HPLC. RESULTS: Median temperatures recorded in the infusion bags worn by the nine patients were in the range 16.7-34.1 degrees C. For infusion bags maintained at 36 degrees C, 26 degrees C and 21-22 degrees C, the concentrations of benzylpenicillin dropped below 90% of the initial concentration at a mean time of 5 h 18 min, 12 h 54 min and 13 h 20 min, respectively, whereas for bags worn by the healthy volunteers the mean time for 10% loss of benzylpenicillin was 9 h 20 min. In contrast, at 3-5 degrees C, concentrations of benzylpenicillin only dropped below 90% of the initial concentration at 8 days. CONCLUSIONS: Significant temperature-dependent degradation of benzylpenicillin occurs during continuous home iv antibiotic programme infusions, which could result in loss of efficacy. (+info)
Out of hospital treatment of patients with melioidosis using ceftazidime in 24 h elastomeric infusors, via peripherally inserted central catheters.
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BACKGROUND: In the tropical north of the Northern Territory, Australia, 25-50 patients are admitted to Royal Darwin Hospital (RDH) each year with Burkholderia pseudomallei infection, or melioidosis. Treatment consists of initial intensive therapy with 2-4 weeks of intravenous antibiotics. Clinical improvement may occur early and patients often prefer to be managed out of hospital in the Hospital in the Home (HITH). OBJECTIVES: To evaluate safety and efficacy of HITH management of patients with melioidosis. METHODS: A prospective observational study of our standard management which consists of 24 h infusions of ceftazidime infused through a peripherally inserted central catheter (PICC) line, plus oral sulphamethoxazole trimethoprim. Treatment is administered in the home, which may be in Darwin, regional areas or remote communities, or in a self-care unit located in the hospital grounds. RESULTS: From February 1998 to December 2001 150 patients were admitted to RDH with culture confirmed B. pseudomallei infection. Of these, 73 patients were treated with 24 h infusions of ceftazidime, of which 70 patients were managed by HITH. Complications of treatment include a PICC line complication rate of 10.6/1000 days in situ. Nine patients had relapse or recrudescence of disease, nearly all as a result of poor adherence to subsequent oral eradication therapy, these patients were all re-treated successfully. One patient remains infected with B. pseudomallei. CONCLUSION: This clinical outcome study suggests that out of hospital management of melioidosis with 24 h infusions of ceftazidime via a PICC line is safe and effective. (+info)