A prospective, randomized, double-blind study was performed to compare preoperative antibiotic preparation with neomycin (group 1), neomycin and tetracycline (group 2), and placebo (group 3) in patients undergoing elective intestinal surgery. The 196 patients were approximately equally distributed among the three study groups, which proved similar to each other in terms of age, sex, diagnosis, site of lesion, and operative procedure. There were significantly (P < 0.01) fewer patients with postoperative wound sepsis in the neomycin-tetracycline group (group 2) than in either of the two other groups. Postoperative wound infection rates in groups 1 and 3 were nearly identical. Most infections contained both aerobic and anaerobic bacteria. Eight of nine episodes of septicemia due to Bacteroides fragilis occurred in patients in groups 1 and 3.
An international study was organized to review blood culture practices in 67 medical centers, most of which were teaching hospitals with a total of over 58,000 active hospital beds. The number of blood cultures per admission was generally greater than 0.5 in the USA and less than 0.5 in other countries. Criteria varied for defining a septic episode, as well as for ascribing clinical importance to isolates of coagulase-negative staphylococci; however, septicemia rates tended to be lower in centers in which clinical evaluation was included among these criteria. Staphylococci were ranked first or second among etiologic agents of septicemia in the USA, whereas Escherichia coli was most frequently ranked first among European and Asian centers. All USA centers recommended collection of two blood cultures per septic episode and all but one recommended a maximum number of blood cultures per septic episode, whereas similar recommendations were less common in Europe and Asia. Collection of more than 10 ml per blood culture was more common in the USA than in Europe or Asia. A variety of broth-based systems were used, often in combination with lysis-centrifugation for special (fungal, mycobacterial) or, on occasion, routine purposes.
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