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To evaluate whether leukocyte esterase activity is a useful biochemical marker of pyuria, we examined urine from 20 healthy volunteers, 47

The pharmacokinetics of spectinomycin hydrochloride after 2 g intravenous doses were studied in ten volunteers with varying degrees of renal function. Mean peak serum concentration in 8 volunteers with renal insufficiency was 150.9 ± (SD) 42.3 μg/ml which was similar to 2 normal volunteers who had concentrations of 139 and 186 μg/ml. Serum half-lives in the volunteers with renal insufficiency ranged from 4.7 to 29.3 h and increased as creatinine clearance decreased. Serum half-lives of the 2 normal volunteers were 1.5 and 1.7 h. Urine concentrations and percents of recovery were variable.

41 SummaryIn 35 normal rabbits the cerebrospinal fluid glucose values ranged between 56 and 135 mg/dl, mean and standard deviation 78 ± 13 mg/dl. Cerebrospinal total protein values ranged from 16 to 66 mg/dl, mean and standard deviation 33 ± 10 mg/dl. The mean values were similar to those reported for human cerebrospinal fluid. Depression of the cerebrospinal glucose level in the rabbit may parallel the human situation and prove to be a useful marker of purulent inflammation.The rabbit model of human meningitis has recently received renewed attention (Delgado Phillips & A vent, 1978; Mitchell, Hinthorn & Liu, 1978; Scheid, Fletcher, Fink & Sande, 1978), and Sorensen, Breen & Benzler (1973) described the cerebrospinal protein, lactic dehydrogenase and cell count in the normal rabbit, and contrasted these values with those obtained after experimental meningeal inflammation. It is well known that the cerebrospinal glucose value is very low in purulent meningitis in man (Thorn, Adams, Braunwald, Isselbacher & Petersdorf, 1977), and it would be helpful to know the normal baseline values in rabbits for experimental reference. To our knowledge this information is not readily available (Jones, 1975 fluid analysis as they utilize small quantities of test fluid (0.2 ml for protein determination and 0.1 ml for glucose determination).Results 35 rabbits were subjected to intraventricular puncture to obtain cerebrospinal fluid. 9 rabbits underwent multiple puncture for protein determination. In 2 rabbits the protein level and in 1 rabbit the glucose level were not measured. The remaining 23 rabbits had a single intraventricular puncture for both protein and glucose determinations. The mean glucose value (± 1 s.d.) was 78 ± 13 mg/dl, with N = 50 (N = total number of determinations

Mezlocillin and carbenicillin were administered intravenously to healthy male volunteers, for six days each, in a double-blind crossover study. Tests to detect abnormalities in haemostasis were performed before, during and after administration. Platelet aggregation studies indicated that both antibiotics interfered with platelet aggregation and secretion resulting in prolonged bleeding times. The effect was dose related and rapidly reversible after discontinuation of the antibiotics. It always occurred earlier and was more profound with carbenicillin than with mezlocillin (P = 0.008). Bleeding times greater than 15 min were observed in 17% of volunteers who received 18 g/day of mezlocillin and 83% of volunteers who received 18 g/day of carbenicillin (P less than 0.05). There were no abnormalities in the coagulation cascade. The risk of acquiring an antibiotic-induced clinical bleeding disorder is lower with mezlocillin than with carbenicillin.

Introduction: Antimicrobial stewardship has been cited as a crucial component of orthopaedic surgical care; however, limited high-quality data exist to guide antibiotic use across the total joint arthroplasty continuum. Antimicrobial stewardship program (ASP) implementation and evaluation is needed in this space. Methods: We pursued a prospective, sequential cohort study of an interprofessional ASP for total joint arthroplasty (TJA) formed in late 2017 at the study institution. Twelve total evidence-based recommendations for protocol change were issued, with 11 accepted and implemented across three project phases spanning March 2018 to December 2019. The primary study outcome was the rate of optimal preoperative intravenous antibiotic selection as assessed for Baseline versus Postintervention time periods. Secondary outcomes included individual antibiotic utilization rates. Descriptive statistics were pursued for institutional surgical site infection (SSI) and postoperative acute kidney injury (AKI) rates across the affected time frame. A cost-benefit analysis of the ASP was estimated from the institutional perspective. Results: The rate of optimal preoperative antibiotic selection increased from 64.9% in the Baseline Period (February 2018, n = 57) to 95.4% in the Postimplementation period (June 2018 to December 2019, n = 1,220) (P , 0.001). The rates of second-line preoperative antibiotics and total perioperative antibiotic exposures decreased. Total SSI and AKI rates in primary elective TJA seemed to decrease from calendar year 2018 to 2019 (deep SSI 1.00% to 0.22%, superficial SSI 0.66% to 0.00%, and AKI 1.97% to 1.03%). The institution realized an estimated $197,050 cost savings per 1000 TJA procedures. Discussion: A comprehensive ASP for TJA was associated with an increased use of optimal preoperative antibiotic selection, decreased total antibiotic exposures, and cost savings, without apparent detriment to SSI or AKI rates.

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