Incidence, risk factors, and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older: a prospective study

Article Abstract:

Surgical procedures to bypass the coronary arteries and repair the heart valves have become more common in recent years, and as the number of surgical procedures has grown, so has the number of patients referred for diagnostic angiography. Angiography, which is merely the visualization of arteries on X-rays, requires the injection of contrast media to make the blood more opaque to X-rays. This injection is not without risks, however, and the major risk is toxic effects on the kidneys. Since elderly people are likely to also have complicating conditions, such as congestive heart failure, kidney insufficiency in an elderly patient may have more serious consequences than the same complication in a younger person. To determine the incidence of and the risk factors involved in renal insufficiency resulting from injection of contrast media, a prospective study of 184 patients over age 70 undergoing angiography was carried out. The subjects underwent cardiac catheterization, the passage of a thin tube into the heart vessels for diagnosis of abnormalities, along with angiography. One of the first indications of inadequate kidney function is a rise in the level of creatinine in the blood. This was observed in 21 patients, or roughly 11 percent. For 16 of these patients, the condition resolved within a few days. One patient experienced a serious drop in urine output, but this condition was also transient. No patients died of kidney complications. The factors which seemed to contribute most to the risk of kidney dysfunction were the use of more than 200 milliliters of contrast medium, serum albumin less than 35 grams per liter, diabetes, serum sodium less than 135 millimoles per liter, and serum creatinine greater than 133 micromoles per liter. These risk factors are similar to those observed for younger patients, as is the incidence of renal insufficiency. Therefore, age alone is not a risk factor for kidney complications from the use of contrast angiography. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Angiography, Coronary arteries, Acute renal failure, Acute kidney failure, Cardiac catheterization, Heart catheterization

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Prospective randomized comparison of mezlocillin therapy alone with combined ampicillin and gentamicin therapy for patients with cholangitis

Article Abstract:

Forty-six patients with cholangitis (inflammation of the bile ducts of the gall bladder) were treated with either mezlocillin sodium or a combination of ampicillin sodium and gentamicin sulfate. The following findings were reported with the mezlocillin therapy: the concentration in the biliary ducts was 100 times higher than that of ampicillin and almost 800 times higher than that of gentamicin; the concentration in the blood and bile was greater than that necessary to inhibit bacterial growth; fewer toxic side effects occurred than with ampicillin-gentamicin therapy; and 80 percent of the patients were cured compared with 40 percent with the antibiotic combination. It is concluded that treatment with mezlocillin is more effective, less toxic and less expensive that treatment with ampicillin and gentamicin for patients with acute cholangitis.

Drug therapy, Cholangitis, Ampicillin, Mezlocillin

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Risk factors for acquisition of gentamicin-resistant enterococci: a multivariate analysis

Article Abstract:

The resistance of the enterococci bacteria (streptococcus in the human intestine) to the gentamicin antibiotic is an increasing problem in hospitalized patients. Forty patients with enterococci infection resistant to gentamicin were compared to 80 patients with the same infection that was successfully treated with gentamicin. Patients in the first group were found to have been in the hospital longer than two weeks and to have received five or more antibiotics during their hospitalization. The data suggest that patients with these two factors are at risk of developing a resistant enterococcus infection and should be monitored in infection control programs.

Case studies, Streptococcal infections, Prevention, Drug resistance in microorganisms, Microbial drug resistance, Microbiology, Cross infection

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