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001-es BibID:BIBFORM008925
Első szerző:Bágyi Kinga (fogszakorvos)
Cím:Role of pathogenic oral flora in postoperative pneumonia following brain surgery / Bágyi Kinga, Haczku Angela, Márton Ildikó, Szabó Judit, Gáspár Attila, Andrási Melinda, Varga Imre, Tóth Judit, Klekner Álmos
Megjegyzések:Post-operative pulmonary infection often appears to result from aspiration of pathogens colonizing the oral cavity. It was hypothesized that impaired periodontal status and pathogenic oral bacteria significantly contribute to development of aspiration pneumonia following neurosurgical operations. Further, the prophylactic effects of a single dose preoperative cefazolin on the oral bacteria were investigated. Methods: A matched cohort of 18 patients without postoperative lung complications was compared to 5 patients who developed pneumonia within 48 hours after brain surgery. Patients waiting for elective operation of a single brain tumor underwent dental examination and saliva collection before surgery. Bacteria from saliva cultures were isolated and periodontal disease was scored according to type and severity. Patients received 15 mg/kg cefazolin intravenously at the beginning of surgery. Serum, saliva and bronchial secretion were collected promptly after the operation. The minimal inhibitory concentrations of cefazolin regarding the isolated bacteria were determined. The actual antibiotic concentrations in serum, saliva and bronchial secretion were measured by capillary electrophoresis upon completion of surgery. Bacteria were isolated again from the sputum of postoperative pneumonia patients. Results: The number and severity of coexisting periodontal diseases were significantly greater in patients with postoperative pneumonia in comparison to the control group (p = 0.031 and p = 0.002, respectively). The relative risk of developing postoperative pneumonia in high periodontal score patients was 3.5 greater than in patients who had low periodontal score (p < 0.0001). Cefazolin concentration in saliva and bronchial secretion remained below detectable levels in every patient. Conclusion: Presence of multiple periodontal diseases and pathogenic bacteria in the saliva are important predisposing factors of postoperative aspiration pneumonia in patients after brain surgery. The low penetration rate of cefazolin into the saliva indicates that its prophylactic administration may not be sufficient to prevent postoperative aspiration pneumonia. Our study suggests that dental examination may be warranted in order to identify patients at high risk of developing postoperative respiratory infections.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
egyetemen (Magyarországon) készült közlemény
Megjelenés:BMC Infectious Diseases. - 9 (2009), p. 104-113. -
További szerzők:Haczku Angela Márton Ildikó (1954-) (fogszakorvos) Szabó Judit (1963-) (szakorvos, klinikai mikrobiológus) Gáspár Attila (1970-) (vegyész, kémikus) Andrási Melinda (1979-) (gyógyszerész) Varga Imre (1960-) (tüdőgyógyász) Tóth Judit (1958-) (onkológus szakorvos) Klekner Álmos (1970-) (idegsebész)
Internet cím:DOI
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001-es BibID:BIBFORM004763
Első szerző:Bágyi Kinga (fogszakorvos)
Cím:Efficacy of pre-operative cephalosporin prophylaxis in controlling pathogenic oral bacterial growth in comatose patients / Bagyi Kinga, Márton Ildikó, Szabó Judit, Andrási Melinda, Gáspár Attila, Varga Imre, Bognár László, Klekner Álmos
Megjegyzések:Pre-operative cephalosporin prophylaxis is routinely administered to patients in many institutes. In the case of patients with long-term endotracheal intubation, saliva that accumulates in the pharynx can flow down into the lungs. In particular, this can occur following neurosurgical procedures in comatose patients when pharyngeal and coughing reflexes are impaired. Aspiration of pathogenic bacteria from the oral cavity can in turn lead to pneumonia. In this study, the efficacy of prophylactic cephalosporins in controlling the growth of oral bacteria was investigated. Methods: At the time of induction of anaesthesia for a neurosurgical procedure, 10, 11, and 9 comatose patients received 1 g of cefazolin, 1.5 g of cefuroxime, or 2 g cefamandole, respectively. Antibiotic concentrations were measured by capillary electrophoresis in the serum and saliva at the end of the procedure. Bacteria were isolated from the same saliva samples and the MIC values for the specific cephalosporin were determined. Results: The mean concentrations of the cephalosporins in the serum exceeded the MIC values for almost every bacterium tested. However, the antibiotic concentrations were much lower in the saliva and did not reach the MIC values of 75-76% of the bacteria isolated from the same source. Conclusions: Surgical prophylaxis with cefazolin, cefuroxime, and cefamandole did not result in effective concentrations in the saliva to control the growth of pathogenic oral flora. Determination of the MIC values for bacteria isolated from the saliva can help in selecting appropriate antibiotics for the prevention of aspiration pneumonia. The simple application of capillary electrophoresis to human biological samples offers the possibility of evaluating the actual effectiveness of antibiotics that can promote optimisation of individual antibiotic therapy.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
aspiration pneumonia
egyetemen (Magyarországon) készült közlemény
Megjelenés:Journal of Medical Microbiology. - 57 : Pt1 (2008), p. 128-129. -
További szerzők:Márton Ildikó (1954-) (fogszakorvos) Szabó Judit (1963-) (szakorvos, klinikai mikrobiológus) Andrási Melinda (1979-) (gyógyszerész) Gáspár Attila (1970-) (vegyész, kémikus) Varga Imre (1960-) (tüdőgyógyász) Bognár László (1958-) (idegsebész, gyermekidegsebész) Klekner Álmos (1970-) (idegsebész)
Internet cím:elektronikus változat
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