Purpose Infection and malignancy represent two common complications after solid organ transplantation, which are often characterized by poorly specific clinical symptomatology. Herein, we have evaluated the role of 18 F-fluoro-2-deoxy-Dglucose (FDG) positron emission tomography/computed tomography (PET/CT) in this clinical setting. Methods Fifty-eight consecutive patients who underwent FDG PET/CT after kidney, lung or heart transplantation were included in this retrospective analysis. Twelve patients underwent FDG PET/CT to strengthen or confirm a diagnostic suspicion of malignancies. The remaining 46 patients presented with unexplained inflammatory syndrome, fever of unknown origin (FUO), CMV or EBV seroconversion during post-transplant follow-up without conclusive conventional imaging. FDG PET/CT results were compared to histology or to the finding obtained during a clinical/imaging follow-up period of at least 6 months after PET/CT study. Results Positive FDG PET/CT results were obtained in 18 (31 %) patients. In the remaining 40 (69 %) cases, FDG PET/CT was negative, showing exclusively a physiological radiotracer distribution. On the basis of a patient-based analysis, FDG PET/CT's sensitivity, specificity, PPV and NPV were respectively 78 %, 90 %, 78 % and 90 %, with a global accuracy of 86 %. FDG PET/CT was true positive in 14 patients with bacterial pneumonias (n = 4), pulmonary fungal infection (n = 1), histoplasmosis (n = 1), cutaneous abscess (n = 1), inflammatory disorder (sacroiliitis) (n = 1), lymphoma (n = 3) and NSCLC (n = 3). On the other hand, FDG PET/CT failed to detect lung bronchoalveolar adenocarcinoma, septicemia, endocarditis and graft-versus-host disease (GVHD), respectively, in four patients. FDG PET/CT contributed to adjusting the patient therapeutic strategy in 40 % of cases. Conclusions FDG PET/CT emerges as a valuable technique to manage complications in the post-transplantation period. FDG PET/CT should be considered in patients with severe unexplained inflammatory syndrome or FUO and inconclusive conventional imaging or to discriminate active from silent lesions previously detected by conventional imaging particularly when malignancy is suspected.
Superinfections originating from a digestive tract colonized by abnormally high concentrations of aerobic microorganisms as a result of impaired resistance to colonization (CR) may complicate antibiotic therapy. In this study, patients with a moderate to severe systemic infection were randomized to receive either cefotaxime (CTX, n = 10) or cotrimoxazole (CTR, n = 10), 2 antibiotic regimens presumed to spare CR; or imipenem/cilastine (I/C, n = 19). The effect on CR was measured indirectly by comparing the aerobic faecal flora before antibiotic treatment with that on day 8 of treatment. An increase in aerobic faecal flora denotes a disturbed CR, whereas a decrease means that the organism is sensitive to the effective faecal concentration of the antibiotic. Imipenem/cilastine-treated patients showed a significant increase in enterococci and Candida spp., while the number of aerobic Gram-negative rods remained constant. Cefotaxime-treated patients had evidence of an increase in enterococci, but not of Candida spp., and Escherichia coli numbers decreased significantly. In these patients the concentration of other Gram-negative aerobic rods showed a slight increase in 6 patients with a resistant Pseudomonas strain. Cotrimoxazole-treated patients showed a significant decrease in aerobic Gram-negative rods, a significant increase in Candida spp. and no change in enterococci. It is concluded that all 3 antimicrobial agents impair colonization resistance. Whether or not this is followed by overgrowth with resistant micro-organisms depends on the active faecal concentration of the antimicrobial agent and the MIC of the aerobic micro-organisms. The risk of overgrowth of the bowel with resistant Gram-negative bacilli appears to be smaller following cotrimoxazole than following cefotaxime or imipenem/cilastine.
The influence of oral administration of cefaclor, phenethicillin, co-trimoxazole and doxycycline on colonization resistance (CR) of the oropharynx and colon in healthy volunteers was studied. Antimicrobial agents were administered in a randomized cross-over design. No effect on CR of the oropharynx could be demonstrated. Phenethicillin decreased CR of the colon against Enterobacteriaceae (P = 0.001). Co-trimoxazole significantly decreased the concentration of Enterobacteriaceae in faeces (P = 0.03) but the decrease caused by cefaclor and doxycycline did not reach statistical significance. Administration of antimicrobial agents increased the appearance of secondary colonization by Enterobacteriaceae in faeces, especially when Escherichia coli was eliminated. During administration of phenethicillin, secondary colonization occurred at a concentration exceeding 10(7)/g in some volunteers. Following administration of cefaclor, co-trimoxazole and doxycycline, elimination of E. coli may result in the substitution by resistant Gram-negative bacilli in low concentrations.
Systemic prophylactic use of antibiotics in surgeryIn 196J BURKE showed in animal experiments that antibiotics affect primary wound infections favourably only if they are administered before or shortly after the bac~ terial contamination. The effect is optimal if an effective tissue concentration does already exist during contamination.Going the operation the infection resistance is strongly reduced, consequently an infection may be caused by then by an inoculum present in a rather low concentration, in any case lower than in normal circumstances the case would be. The reduced infection resistance lasts until only a few hours after operation. Prophylactic use of antibiotics therefore needs to be continued only until a short time after the final stage of the operation.Since i969 a great number of clinical trials have definitely shown that short term, peri-operative prophylactic use of antibiotics causes a strong reduction in the incidence of wound infections. Prophylactic use of antibiotics therefore is justified if the height of the infection risk or the danger of possible complications are outranging certain limits. These limits bear a subjective character, however.The risk factors in the development of wound infections and the choice of the antibiotic are discussed. SAMENVATTINGIn I961 toonde SURKE in dierexperimenten aan dat antibiotica een primaire wondinfectie slechts gunstig beinvloeden als zij v66r of kort na de bacteriSle contaminatie worden toegediend. Het effect is optimaal als reeds tijdens de contaminatie een effectieve weefselconcentratie van het antibioticum bestaat.Tijdens de operatic is de infectieweerstand sterk verlaagd, zodat dan een infectie kan worden veroorzaakt door een concentratie bacterieel inoculum dat daarvoor onder normale omstandigheden veel te klein zou zijn. De verlaging van de infectieweerstand houdt slechts aan tot enkele uren na de operatie. Profylactisch antibioticagebruik behoeft daarom slechts tot kort na de operatic te worden voortgezet.Sinds t969 is in een groot aantal klinische onderzoekingen duidelijk aangetoond dat kortdurend, peri-operatief, profylactisch antibioticagebruik een sterke vermindering van het wondinfectiepercentage kan geven. Profylactisch antibioticagebruik is daarom verantwoord als de hoogte van het infectierisico of de ernst van de mogelijke complicaties bepaalde (subjectieve) grenzen te boven gaan.a Apotheker Canisius-Wilhelmin a Ziekenhuis, St. Annastraat Risicofactoren voor het ontstaan van wondinfecties en de keuze van het te gebruiken antibioticum worden besproken.I. INLEIDING Tot voor kort werd profylactisch gebruik van antibiotica in de literatuur vrij algemeen beschouwd als antibiotica-misbruik. De nadelen, zoals kans op intoxicatie, overgevoeligheidsreacties, resistentie-ontwikkeling en superinfecties, golden als niet acceptabet omdat uit klinische onderzoekingen meestal g66n vermindering van het postoperatief infectiepercentage was gebleken; veelal was het infectiepercentage in de behandelde groep zelfs (veel) hoger dan in de placebogr...
The influence of clindamycin, dicloxacillin, minocycline and norfloxacin on the faecal concentration of urobilinogen was investigated. The studied drugs were administered orally in standard dosage for six days to groups of six volunteers. A decrease in faecal concentration of urobilinogen following administration of clindamycin (P less than 0.01) and dicloxacillin (P less than 0.05) was found. The possible predictive value of a decrease of the faecal level of urobilinogen as an indicator for the impairment of microbial colonization resistance and for the risk of failure of oral anticonceptive treatment is discussed. It is suggested that clindamycin and dicloxacillin should not be combined with oral anticonceptive treatment unless more specific investigations have excluded interaction of these drugs with the oestrogen metabolism in the bowel.
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