Novel Modes of Action of Aminoglycoside Antibiotics Against Pseudomonas Aeruginosa

Novel Modes of Action of Aminoglycoside Antibiotics Against Pseudomonas Aeruginosa

0022-5347//88/1406-1599$2.00/0 Vol. 140, December Printed in U.S.A. THE JOURNAL OF UROLOGY Copyright© 1988 by The Williams & Wilkins Co. ABSTRACTS ...

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0022-5347//88/1406-1599$2.00/0 Vol. 140, December Printed in U.S.A.

THE JOURNAL OF UROLOGY

Copyright© 1988 by The Williams & Wilkins Co.

ABSTRACTS INFECTIONS AND ANTIBIOTICS Vesicoureteral Reflux in the Primate. IV. Infection as Cause of Prolonged High-Grade Reflux

Guidelines for Improving the Use of Antimicrobial Agents in Hospitals: A Statement by the Infectious Diseases Society of America

J_ A. ROBERTS, M. B. KAACKAND A. B. MORVANT, Department of Urology, Tulane University, Delta Regional Primate Research Center, Covington and Tulane University School of Medicine, New Orleans, Louisiana

J. J. MARR, H. L. MOFFET AND C. M. KUNIN, Department of Medicine, University of Colorado, Denver, Colorado; Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, and Department of Medicine, Ohio State University, Columbus, Ohio

Pediatrics, 82: 91-95 (July) 1988

J. Infect. Dis., 156: 869-876 (May) 1988

The authors postulate that high grade reflux does not disappear as rapidly as moderate reflux due to infection and that this infection might affect the ureteral function. A total of 8 infant monkeys underwent an operation to produce vesicoureteral reflux and bladder neck obstruction. High grade reflux was confirmed by cystogram and renal function studies demonstrating a 20 per cent decrease in renal function of the side with reflux. After 4 months the bladder neck obstruction was relieved in 4 monkeys. In the other 4 monkeys the bladder neck obstruction was relieved and at the same time the bladder was inoculated with Escherichia coli. The animals were studied for 2 years. The animals in the control group had reflux for approximately 4 months and then the reflux disappeared spontaneously. In the group with infection the reflux continued for 18 months. The authors conclude from this study that infection explains the differences in the timing of cessation of reflux and that the treatment of urinary tract infection rather than vesicoureteral reflux itself is the most important therapy in children with reflux. 5 figures, 1 table, 27 references Robert Kay, M.D. Cleveland, Ohio

This study represents the first in a series of reports by the Infectious Diseases Society of America addressing the issues involved in antimicrobial therapy. The purpose of this report is to aid hospital staffs to develop policies to survey antimicrobial use at their institutions, provide quality assurance, guarantee availability of the best agents and decrease the emergence of resistant strains while controlling costs. To attain these goals they suggest that routine evaluation of antimicrobial use in the hospital be performed. This should include studies of formulary practice, trends in use, microbiology laboratory practices, trends in bacterial resistance and patterns of antibiotic use by the medical staff. To implement these studies they recommend the establishment of an antimicrobial agents team, with a qualified infectious diseases physician as leader. This physician should be a member of the hospital's pharmacy, and therapeutics and infection control committees. Other team members should be an infection control practitioner, clinical microbiologist and clinical pharmacist. They would work together to advise the medical staff in choice of optimal antibiotics for patient care. Cost considerations would be of secondary but not insignificant concern. They also would help to select the antibiotics on formulary, run educational programs, and implement related hospital and staff policy. If this team is accepted and supported by the hospital, the Infectious Diseases Society of America believes that the net effect will be improved patient care and decreased antimicrobial resistance in the hospital setting. 1 figure, 73 references Mark J. Schacht, M.D. Chicago, Illinois

Novel Modes of Action of Aminoglycoside Antibiotics Against Pseudomonas Aeruginosa

G.

MORRIS AND M. R. W. BROWN, Microbiology Research Group, Department of Pharmaceutical Sciences, Aston University, Birmingham, United Kingdom

Lancet, 1: 1359-1361 (June 18) 1988

ONCOLOGY AND CHEMOTHERAPY More than 80 per cent of strains of Pseudomonas isolated from patients with cystic fibrosis produce copious amounts of a virulence factor, alginate, an extracellular polysaccharide. Renal Cell Carcinoma: Surgical Management of Regional Lymph Nodes and Inferior Vena-Caval Tumor Chemical characteristics of the alginate secreted may hinder Thrombus bactericidal concentrations of drug reaching the bacteria. The authors studied the effects of subinhibitory concentrations of F. F. MARSHALL, James Buchanan Brady Urological Institute, various {1-lactams, ciprofloxacin and aminoglycosides on PseuJohns Hopkins Medical Institutions, Baltimore, Maryland domonas aeruginosa. At concentrations that did not inhibit growth aminoglycosides, cefotaxime and ciprofloxacin reduced Sem. Surg. Oneal., 4: 129-132, 1988 In this brief literature review the author discusses his philosalginate production. They also inhibited several aspects of bacterial iron (and, therefore, energy) metabolism. These ef- ophy for the treatment of patients with renal cell carcinoma fects of various antibiotics on virulence factors are likely to and vena caval tumor thrombus. He also makes recommendations for the surgical management of regional lymph nodes. contribute to their efficacy. The lymphatic drainage of the left kidney extends from the 1 figure, 1 table, 28 references James H. Nelson, III, M.D. inferior mesenteric artery to the crus of the diaphragm, with Columbus, Ohio lymph nodes being found in front of and behind the aorta. The 1599