Bacteriuria is common in chronically catheterized patients and is associated with both acute and chronic complications. Of 605 consecutive weekly urine specimens from 20 chronically catheterized patients, 98% contained bacteria at high concentrations and 77% were polymicrobial. The mean interval between new episodes of bacteriuria was 1.8 weeks. Most species of bacteria caused five to seven new episodes of bacteriuria per 100 weeks of catheterization. Even though access to the catheter lumen was similar, the duration of bacteriuric episodes varied greatly by species. Of the episodes of bacteriuria caused by nonenterococcal gram-positive cocci, greater than 75% lasted less than one week. Mean durations of episodes of bacteriuria due to Escherichia coli, Proteus mirabilis, and Pseudomonas aeruginosa were four to six weeks, whereas those due to Providencia stuartii averaged 10 weeks and ranged up to 36 weeks. Thus, the very high prevalence of bacteriuria--virtually 100%--was a result of a high incidence caused by many different species combined with the prolonged residence of some gram-negative bacilli in the catheter and urinary tract.

Use of three characteristics (ie skin ulcers, urethral catheters, bedfast status) to identify patients at risk for nursing home-acquired infections may allow targeted infection surveillance and prevention programs. In addition, nursing home-acquired infections are not evaluated uniformly across patients and facilities, suggesting the need to establish, through further study, guidelines for such evaluations.

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Numbers of nursing home beds now exceed hospital beds in the United States and are usually occupied by women. Urinary incontinence is very common and may be managed with long-term urethral catheters. Bacteriuria invariably results, yet its clinical consequences are not well known. We studied 47 catheterized and bacteriuric women for almost 25 patient-years. The incidence of febrile episodes of possible urinary origin was 1.1 episodes/100 patient-days. Because these were diagnoses of exclusion, even this low incidence may be an overestimate. Most of these episodes were of less than or equal to 38.3 C (101.0 F), lasted for less than one day, and resolved without antibiotic therapy. Six deaths, half the total from all causes, occurred during these episodes, an incidence 60 times that during afebrile periods. Deaths and bacteremias were significantly associated with episodes of greater than or equal to 38.8 C (102.0 F). In the individual patient, these risks should be weighed against benefits of patient comfort, family satisfaction, and prevention and management of decubitus ulcers.

The pharmacokinetics of cefepime in 31 young, healthy volunteers were assessed after the administration of single and multiple 250-, 500-, 1,000-, or 2,000-mg intravenous doses. Each subject received a single dose of cefepime via a 30-min intravenous infusion on day 1 of the study. Starting from day 2, subjects received multiple doses of cefepime every 8 h for 9 days, and on the morning of day 11, they received the last dose. Serial blood and urine samples were collected after administration of the first dose and on days 1, 6, and 11. Cefepime concentrations in plasma and urine were assayed by using reverse-phase high-performance liquid chromatography with UV detection. Data were evaluated by noncompartmental methods to determine pharmacokinetic parameters. The mean half-life of cefepime was approximately 2 h and did not vary with the dose or duration of dosing. The regression analyses of peak levels (Cm.) in plasma at the end of the 30-min intravenous infusion and the area under the plasma concentration-versus-time curve (AUC>o.) showed a dose-proportional response. The steady-state volume of distribution (V,,) was approximately 18 liters and was independent of the administered dose. The multiple-dose pharmacokinetic data are suggestive of a lack of accumulation or change in clearance of cefepime on repeated dosing. Cefepime was excreted primarily unchanged in urine. The recovery of intact cefepime in urine was invariant with respect to the dose and accounted for over 80%o of the dose. The values for renal clearance ranged from 99 to 132 ml/min and were suggestive of glomerular filtration as the primary excretion mechanism. It is concluded that cefepime exhibits linear phannacokinetics in healthy subjects.