Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1977 Oct;32(5):596–600. doi: 10.1136/thx.32.5.596

An antibiotic policy for bacterial infections after thoracic and other injuries

S T Atherton 1,1, D M Wright 1,2, D J White 1, E S Jones 1
PMCID: PMC470796  PMID: 594941

Abstract

Atherton, S. T., Wright, D. M., White, D. J., and Jones, E. S. (1977).Thorax,32, 596-600. An antibiotic policy for bacterial infections after thoracic and other injuries. Twenty-four patients suffering from thoracic and other injuries were admitted to an intensive care unit over a three-year period. The first four patients died from infection by Gram-negative bacilli with associated features of bacterial toxaemia although it was anticipated that most, if not all, of the patients would have recovered with intensive care. Antibiotics had been started when a patient showed signs of bacterial toxaemia but were ineffective. Retrospective analysis showed that, in each patient, a rapid rise in rectal temperature, white cell count, and blood sugar preceded the clinical features of bacterial toxaemia by one or two days. These observations were incorporated into an antibiotic policy for patients with similar injuries.

The criteria for starting two or three wide spectrum antibiotics were as follows: (1) Gram-negative bacilli in the tracheal aspirate together with radiological evidence of consolidation or absorption collapse; (ii) two of the following three signs—a rectal temperature of 38·5°C or more, a white blood cell count of 11·0 × 109/l or above, a blood glucose of 11·2 mmol/l or above; (iii) laparotomy. This policy was tested out over two years on 20 patients with thoracic and other injuries. Sixteen of the patients fulfilled the criteria for antibiotic therapy. Two of the six deaths were due to bacterial infection with toxaemia, a result which suggests that the policy was beneficial.

Full text

PDF
596

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ambiavagar M., Robinson J. S., Morrison I. M., Jones E. S. Intermittent positive pressure ventilation in the treatment of severe crushing injuries of the chest. Thorax. 1966 Jul;21(4):359–366. doi: 10.1136/thx.21.4.359. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bennett J. V., Brodie J. L., Benner E. J., Kirby W. M. Simplified, accurate method for antibiotic assay of clinical specimens. Appl Microbiol. 1966 Mar;14(2):170–177. doi: 10.1128/am.14.2.170-177.1966. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Caridis D. T., Reinhold R. B., Woodruff P. W., Fine J. Endotoxaemia in man. Lancet. 1972 Jun 24;1(7765):1381–1385. doi: 10.1016/s0140-6736(72)91108-7. [DOI] [PubMed] [Google Scholar]
  4. Cuevas P., Fine J., Monaco A. P. Successful induction of increased resistance to gram-negative bacteria and to endotoxin in immunosuppressed mice. Am J Surg. 1974 Apr;127(4):460–464. doi: 10.1016/0002-9610(74)90297-9. [DOI] [PubMed] [Google Scholar]
  5. Elin R. J., Robinson R. A., Levine A. S., Wolff S. M. Lack of clinical usefulness of the limulus test in the diagnosis of endotoxemia. N Engl J Med. 1975 Sep 11;293(11):521–524. doi: 10.1056/NEJM197509112931102. [DOI] [PubMed] [Google Scholar]
  6. Freeman R., King B., Hambling M. H. Infective complications of open-heart surgery and the monitoring of infections by the NBT test. Thorax. 1973 Sep;28(5):617–621. doi: 10.1136/thx.28.5.617. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Gett P. M., Jones E. S., Shepherd G. F. Pulmonary oedema associated with sodium retention during ventilator treatment. Br J Anaesth. 1971 May;43(5):460–470. doi: 10.1093/bja/43.5.460. [DOI] [PubMed] [Google Scholar]
  8. Jones E. S., Peaston M. J. Metabolic care during acute illnesses. Practitioner. 1966 Feb;196(172):271–275. [PubMed] [Google Scholar]
  9. Levin J. Endotoxin and endotoxemia. N Engl J Med. 1973 Jun 14;288(24):1297–1298. doi: 10.1056/NEJM197306142882411. [DOI] [PubMed] [Google Scholar]
  10. MacLean L. D., Mulligan W. G., McLean A. P., Duff J. H. Patterns of septic shock in man--a detailed study of 56 patients. Ann Surg. 1967 Oct;166(4):543–562. doi: 10.1097/00000658-196710000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Price D. J., Sleigh J. D. Control of infection due to Klebsiella aerogenes in a neurosurgical unit by withdrawal of all antibiotics. Lancet. 1970 Dec 12;2(7685):1213–1215. doi: 10.1016/s0140-6736(70)92179-3. [DOI] [PubMed] [Google Scholar]
  12. Stumacher R. J., Kovnat M. J., McCabe W. R. Limitations of the usefulness of the Limulus assay for endotoxin. N Engl J Med. 1973 Jun 14;288(24):1261–1264. doi: 10.1056/NEJM197306142882402. [DOI] [PubMed] [Google Scholar]
  13. Wardle E. N. Endotoxinaemia and the pathogenesis of acute renal failure. Q J Med. 1975 Apr;44(174):389–398. [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES