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Enache AC, Samoila P, Cojocaru C, Bele A, Bostanaru AC, Mares M, Harabagiu V. Amphiphilic Chitosan Porous Membranes as Potential Therapeutic Systems with Analgesic Effect for Burn Care. MEMBRANES 2022; 12:973. [PMID: 36295732 PMCID: PMC9611202 DOI: 10.3390/membranes12100973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Eliminating or at least lessening the pain is a crucial aspect of burns management, as pain can negatively affect mental health and quality of life, and it can also induce a delay on wound healing. In this context, new amphiphilic chitosan 3D porous membranes were developed and investigated as burns therapeutic systems with analgesic effect for delivery of lidocaine as local anesthetic. The highly porous morphology of the membranes and the structural modifications were evidenced by scanning electron microscopy (SEM), energy dispersive X-ray (EDX) analysis and infrared spectroscopy (FTIR). Improved compression mechanical properties, long-term hydrolytic degradation (28 days) evaluation and high swelling capacities (ranging from 8 to 22.6 g/g) indicate an increased capacity of the prepared membranes to absorb physiological fluids (burns exudate). Lidocaine in vitro release efficiency was favored by the decreased content of cross-linking agent (reaching maximum value of 95.24%) and the kinetic data modeling, indicating that lidocaine release occurs by quasi-Fickian diffusion. In addition to the in vitro evaluation of analgesic effect, lidocaine-loaded chitosan membranes were successfully investigated and proved antibacterial activity against most common pathogens in burns infections: Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus.
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Affiliation(s)
- Andra-Cristina Enache
- Laboratory of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, 41A Grigore Ghica Voda Alley, 700487 Iasi, Romania
| | - Petrisor Samoila
- Laboratory of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, 41A Grigore Ghica Voda Alley, 700487 Iasi, Romania
| | - Corneliu Cojocaru
- Laboratory of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, 41A Grigore Ghica Voda Alley, 700487 Iasi, Romania
| | - Adrian Bele
- Laboratory of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, 41A Grigore Ghica Voda Alley, 700487 Iasi, Romania
| | - Andra-Cristina Bostanaru
- Laboratory of Antimicrobial Chemotherapy, “Ion Ionescu de la Brad” University of Life Sciences, 8 Mihail Sadoveanu Alley, 700489 Iasi, Romania
| | - Mihai Mares
- Laboratory of Antimicrobial Chemotherapy, “Ion Ionescu de la Brad” University of Life Sciences, 8 Mihail Sadoveanu Alley, 700489 Iasi, Romania
| | - Valeria Harabagiu
- Laboratory of Inorganic Polymers, “Petru Poni” Institute of Macromolecular Chemistry, 41A Grigore Ghica Voda Alley, 700487 Iasi, Romania
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Martinu T, Koutsokera A, Benden C, Cantu E, Chambers D, Cypel M, Edelman J, Emtiazjoo A, Fisher AJ, Greenland JR, Hayes D, Hwang D, Keller BC, Lease ED, Perch M, Sato M, Todd JL, Verleden S, von der Thüsen J, Weigt SS, Keshavjee S. International Society for Heart and Lung Transplantation consensus statement for the standardization of bronchoalveolar lavage in lung transplantation. J Heart Lung Transplant 2020; 39:1171-1190. [PMID: 32773322 PMCID: PMC7361106 DOI: 10.1016/j.healun.2020.07.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 01/09/2023] Open
Abstract
Bronchoalveolar lavage (BAL) is a key clinical and research tool in lung transplantation (LTx). However, BAL collection and processing are not standardized across LTx centers. This International Society for Heart and Lung Transplantation-supported consensus document on BAL standardization aims to clarify definitions and propose common approaches to improve clinical and research practice standards. The following 9 areas are covered: (1) bronchoscopy procedure and BAL collection, (2) sample handling, (3) sample processing for microbiology, (4) cytology, (5) research, (6) microbiome, (7) sample inventory/tracking, (8) donor bronchoscopy, and (9) pediatric considerations. This consensus document aims to harmonize clinical and research practices for BAL collection and processing in LTx. The overarching goal is to enhance standardization and multicenter collaboration within the international LTx community and enable improvement and development of new BAL-based diagnostics.
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Affiliation(s)
- Tereza Martinu
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Angela Koutsokera
- Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Lung Transplant Program, Division of Pulmonology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Edward Cantu
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel Chambers
- Lung Transplant Program, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Marcelo Cypel
- Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey Edelman
- Lung Transplant Program, Puget Sound VA Medical Center, Seattle, Washington
| | - Amir Emtiazjoo
- Lung Transplant Program, University of Florida, Gainesville, Florida
| | - Andrew J Fisher
- Institute of Transplantation, Newcastle Upon Tyne Hospitals and Newcastle University, United Kingdom
| | - John R Greenland
- Department of Medicine, VA Health Care System, San Francisco, California
| | - Don Hayes
- Lung Transplant Program, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David Hwang
- Department of Pathology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Brian C Keller
- Lung Transplant Program, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Erika D Lease
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Michael Perch
- Lung Transplant Program, Rigshospitalet, Copenhagen, Denmark
| | - Masaaki Sato
- Department of Surgery, University of Tokyo, Tokyo, Japan
| | - Jamie L Todd
- Lung Transplant Program, Duke University Medical Center, Durham, North Carolina
| | - Stijn Verleden
- Laboratory of Pneumology, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - S Samuel Weigt
- Lung Transplant Program, University of California Los Angeles, Los Angeles, California
| | - Shaf Keshavjee
- Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Kesici U, Demirci M, Kesici S. Antimicrobial effects of local anaesthetics. Int Wound J 2019; 16:1029-1033. [PMID: 31148374 DOI: 10.1111/iwj.13153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/11/2019] [Accepted: 05/12/2019] [Indexed: 12/26/2022] Open
Abstract
After the introduction of cocaine to the medical practice, local anaesthetics (LA) became essential in pain control. LA infiltration along the incision may be used to provide surgical anaesthesia or postoperative analgesia. This study aimed to compare the antimicrobial effects of the topical antimicrobial agent mupirocine with those of the LA lidocaine and the combination of lidocaine and adrenalin. In our study, the in vitro antimicrobial effects of 1 mL sterile saline, 20 mg/mL mupirocine, 20 mg/mL Lidocaine, and 20 mg/mL Lidocaine and Adrenaline were tested against Staphylococcus aureus American type culture collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, and Escherichia coli ATCC 25922 as Group C (Control), Group M (Mupirocine), Group L (Lidocaine), and Group LA (Lidocaine + adrenaline), respectively. S aureus ATCC 29213, P aeruginosa ATCC 27853, and E coli ATCC 25922 were cultured onto Mueller-Hinton agar (Oxoid, UK) plates for 18 to 24 hours at 37°C. Colonies from these plates were suspended in sterile saline and a 0.5 McFarland turbidity standard suspension (corresponding to 1.5 × 108 CFU/mL) of each isolate was prepared. S Aureus ATCC 29213 inhibition zone diameter values of Group M, Group LA, and Group L were significantly higher compared with the group C (P ˂ 0.05). P aeruginosa ATCC 27853 inhibition zone diameter values of Group M and Group LA were significantly higher compared with the group C (P ˂ 0.05). E coli ATCC 25922 inhibition zone diameter values of Group M, Group LA, and Group L were significantly higher compared to the group C (P ˂ 0.05). LA infiltration along the incision may be used to provide surgical anaesthesia or postoperative analgesia. Considering that LAs show antimicrobial effects besides their analgesic effects, they may contribute to preventing the development and reducing the rate of surgical infections, decreasing the requirement to administer antibiotics. However, caution should be exercised not to antagonise the effective treatment of surgical infections, remembering that controversy on the antimicrobial effects of LAs remains in the literature. Therefore, further comprehensive studies with larger patient populations are warranted to demonstrate the antimicrobial effects of LAs.
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Affiliation(s)
- Ugur Kesici
- Faculty of Medicine, Department of General Surgery, University of Beykent, Istanbul, Turkey
| | - Mehmet Demirci
- Faculty of Medicine, Department of Microbiology, University of Beykent, Istanbul, Turkey
| | - Sevgi Kesici
- Department of Anesthesiology and Reanimation, Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Razavi BM, Fazly Bazzaz BS. A review and new insights to antimicrobial action of local anesthetics. Eur J Clin Microbiol Infect Dis 2019; 38:991-1002. [PMID: 30680564 DOI: 10.1007/s10096-018-03460-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 12/17/2018] [Indexed: 11/25/2022]
Abstract
Local anesthetics (LAs) are medications which can provide analgesia in distinct body regions through the blockade of voltage-gated sodium channels. Besides pain management, the supplemental role of LAs as antimicrobial agents has been documented in several studies. Different databases including PubMed, Scopus, and Web of Science with the name of different local anesthetics and related names for antimicrobial keywords were searched without time limitation. This review summarized different in vitro and in vivo studies regarding antimicrobial effects of different LAs with focuses on antimicrobial applications of most studied LAs, interaction with different agents which combined with LAs, and mechanisms of action and structural dependence of LAs antibacterial effects. Among different LAs, lidocaine is the most studied preparation. Reduction of the incidence of endophthalmitis after intravitreal injection, prophylaxis for surgical wound infections, prevention of the incidence of catheter-associated infections, oral biofilm reduction on the buccal mucosa, and prevention against bacteria that produced nosocomial infection are some examples of lidocaine antimicrobial application. Studies showed that different factors including structure, concentration, duration of exposure, type of microorganism tested, and temperature affect the degree of LA antimicrobial activity. In addition, various agents such as antibiotics, preservatives, opioids, epinephrine, and propofol can combine with LAs and affect their antimicrobial properties through synergistic or antagonistic action. Due to antibacterial activities, LAs could be applied in a clinic for prophylaxis of surgical site infection. In the application of LAs prior to diagnostic procedures caution should be needed; otherwise, when culturing the specimen, they could lead to false negative results.
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Affiliation(s)
- Bibi Marjan Razavi
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bibi Sedigheh Fazly Bazzaz
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
- Pharmaceutical Control Department, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Liu K, Ye L, Sun W, Hao L, Luo Y, Chen J. Does Use of Lidocaine Affect Culture of Synovial Fluid Obtained to Diagnose Periprosthetic Joint Infection (PJI)? An In Vitro Study. Med Sci Monit 2018; 24:448-452. [PMID: 29360804 PMCID: PMC5791422 DOI: 10.12659/msm.908585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Synovial fluid culture (SFC) is recommended as one of the major diagnostic criteria by the Musculoskeletal Infection Society (MSIS) for diagnosing periprosthetic joint infection (PJI). Local anesthetic agents are used for anesthesia and analgesia in some clinical settings to relieve pain. As a local anesthetic, lidocaine is safely used in arthrocentesis to obtain synovial fluid. The goal of this study was to determine if infiltration anesthesia with additive-free lidocaine 2% has antibacterial effects that might interfere with subsequent SFC. Material/Methods Eight isolates of reference strains of Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis, Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Streptococcus pyogenes, and Candida albicans were incubated on the plates. Each bacterial suspension was formed by 50-fold dilution before the test lidocaine 2% was added. For each strain, bacterial suspension was divided into 2 groups (5 samples each) exposed either lidocaine 2% or sterile non-bacteriostatic 0.45% saline. The antimicrobial property of lidocaine 2% was determined by measuring the bacterial density on agar plates incubated for 24 h and comparing it with controls unexposed to lidocaine 2%. Results Exposure to lidocaine 2% negatively affected microbial viability in vitro. Of the lidocaine 2% exposure, reference strains but no Streptococcus pyogenes strain resulted in fewer colony-forming units compared with the sterile saline control. The antibacterial property of lidocaine 2% appears to affect the ability to culture the organism in synovial fluid. Conclusions Lidocaine 2% has strong antimicrobial activities against some commonly encountered bacterial strains in PJI. As a result, infiltration anesthesia with additive-free lidocaine 2% before the arthrocentesis procedure may affect the results of SFC. To further evaluate its potential antibacterial usefulness in clinical applications, studies are needed to assess the ability of lidocaine to reduce the risk of iatrogenic infections.
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Affiliation(s)
- Kan Liu
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
| | - Liyan Ye
- Department of Clinical Microbiology, General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
| | - Wei Sun
- Intensive Care Unit, Nanyuan Hospital, Beijing, China (mainland)
| | - Libo Hao
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
| | - Yanping Luo
- Department of Clinical Microbiology, General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
| | - Jiying Chen
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
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Singhal P, Sreedhar G, Singh NN, Sharma D, Bannerji S, Gowhar O. Evaluation of histomorphometric changes in tissue architecture due to fixation delay. J Oral Maxillofac Pathol 2017; 21:70-75. [PMID: 28479690 PMCID: PMC5406822 DOI: 10.4103/0973-029x.203771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: All good tissue specimen preparations require complete fixation. The process of tissue handling and processing from patient to paraffin block is too frequently invisible to the pathologists. Many times due to certain emergencies or unavailability of a proper fixative, tissues are kept in different carrying media such as normal saline (NS) or local anesthetic till the availability of a proper fixative solution. This fixation delay can lead to various tissue architectural changes which can affect its diagnostic value. Aims: The aim of this study was to assess sectioning ability, staining intensity and microscopic details of tissues kept in different carrying media at different time intervals followed by standard fixation. Materials and Methods: Fresh tissue specimen, i.e., goat tongue was collected and its middle portion was retained and was used for study purpose. The tissue was grossed and kept in various carrying media for five different time intervals. Standard formaldehyde fixation was then carried out followed by sectioning and staining. The sections were evaluated histologically under light microscope. Statistical Analysis: For sectioning parameter, Fisher's exact test and for staining and microscopic details, Mann–Whitney U-test was used. Results: According to the study, NS is considered as a best carrying media followed by 10% honey and local anesthetic. Two percent hydrogen peroxide cannot be used as a carrying media. Conclusion: It was concluded that NS should be given first preference as a carrying media till the availability of a suitable fixative. Clinicians and Pathologists should have to familiarize themselves with the advantages and disadvantages of using various carrying media and the histomorphometric changes associated with delayed fixation which may lead to incorrect diagnosis.
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Affiliation(s)
- Pallav Singhal
- Department of Oral Pathology and Microbiology, Sarjug Dental College, Darbhanga, Bihar, India
| | - Gadiputi Sreedhar
- Department of Oral Pathology and Microbiology, Babu Banarasi Das College of Dental Sciences, Lucknow, India
| | - Narendra Nath Singh
- Department of Oral Pathology and Microbiology, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Divya Sharma
- Department of Oral Pathology and Microbiology, Swami Devi Dayal Dental College, Panchkula, Haryana, India
| | - Sumita Bannerji
- Department of Oral Pathology and Microbiology, The Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Owais Gowhar
- Department of Dentistry, J and K Health and Family Welfare Department, Kashmir, India
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Shah V, Taddio A, McMurtry CM, Halperin SA, Noel M, Pillai Riddell R, Chambers CT. Pharmacological and Combined Interventions to Reduce Vaccine Injection Pain in Children and Adults: Systematic Review and Meta-Analysis. Clin J Pain 2015; 31:S38-63. [PMID: 26201016 PMCID: PMC4900424 DOI: 10.1097/ajp.0000000000000281] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 06/29/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND This systematic review assessed the effectiveness and safety of pharmacotherapy and combined interventions for reducing vaccine injection pain in individuals across the lifespan. DESIGN/METHODS Electronic databases were searched for relevant randomized and quasi-randomized controlled trials. Self-reported pain and fear as well as observer-rated distress were critically important outcomes. Data were combined using standardized mean difference (SMD) or relative risk with 95% confidence intervals (CI). RESULTS Fifty-five studies that examined breastfeeding (which combines sweet-tasting solution, holding, and sucking), topical anesthetics, sweet-tasting solutions (sucrose, glucose), vapocoolants, oral analgesics, and combination of 2 versus 1 intervention were included. The following results report findings of analyses of critical outcomes with the largest number of participants. Compared with control, acute distress was lower for infants breastfed: (1) during vaccination (n=792): SMD -1.78 (CI, -2.35, -1.22) and (2) before vaccination (n=100): SMD -1.43 (CI, -2.14, -0.72). Compared with control/placebo, topical anesthetics showed benefit on acute distress in children (n=1424): SMD -0.91 (CI, -1.36, -0.47) and self-reported pain in adults (n=60): SMD -0.85 (CI, -1.38, -0.32). Acute and recovery distress was lower for children who received sucrose (n=2071): SMD -0.76 (CI, -1.19, -0.34) or glucose (n=818): SMD -0.69 (CI, -1.03, -0.35) compared with placebo/no treatment. Vapocoolants reduced acute pain in adults [(n=185), SMD -0.78 (CI, -1.08, -0.48)] but not children. Evidence from other needle procedures showed no benefit of acetaminophen or ibuprofen. The administration of topical anesthetics before and breastfeeding during vaccine injections showed mixed results when compared with topical anesthetics alone. There were no additive benefits of combining glucose and non-nutritive sucking (pacifier) compared with glucose or non-nutritive sucking (pacifier) alone or breastfeeding and sucrose compared with breastfeeding or sucrose alone. CONCLUSIONS Breastfeeding, topical anesthetics, sweet-tasting solutions, and combination of topical anesthetics and breastfeeding demonstrated evidence of benefit for reducing vaccine injection pain in infants and children. In adults, limited data demonstrate some benefit of topical anesthetics and vapocoolants.
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Affiliation(s)
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto
- The Hospital for Sick Children
| | - C. Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph
- Children’s Health Research Institute, London
- Department of Paediatrics, Western University, London, ON
| | - Scott A. Halperin
- Departments of Pediatrics and Microbiology and Immunology, IWK Health Centre, Dalhousie University
| | - Melanie Noel
- Department of Psychology, University of Calgary, AB, Canada
| | | | - Christine T. Chambers
- Department of Pediatrics and Psychology, Faculty of Science, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
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Örtqvist Å. Prognosis in Community-Acquired Pneumonia Requiring Treatment in Hospital: Importance of Predisposing and Complicating Factors, and of Diagnostic Procedures. ACTA ACUST UNITED AC 2015. [DOI: 10.3109/inf.1989.21.suppl-65.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bartlett JG. Anaerobic bacterial infection of the lung. Anaerobe 2012; 18:235-9. [DOI: 10.1016/j.anaerobe.2011.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 12/05/2011] [Accepted: 12/07/2011] [Indexed: 10/14/2022]
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Shah V, Taddio A, Rieder MJ. Effectiveness and tolerability of pharmacologic and combined interventions for reducing injection pain during routine childhood immunizations: Systematic review and meta-analyses. Clin Ther 2009; 31 Suppl 2:S104-51. [DOI: 10.1016/j.clinthera.2009.08.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2009] [Indexed: 11/16/2022]
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Berg JO, Mössner BK, Skov MN, Lauridsen J, Gottrup F, Kolmos HJ. Antibacterial properties of EMLA and lidocaine in wound tissue biopsies for culturing. Wound Repair Regen 2007; 14:581-5. [PMID: 17014670 DOI: 10.1111/j.1743-6109.2006.00157.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
If a tissue biopsy from a chronic wound is sampled for culture, the antibacterial properties of local anesthetics may pose a problem in producing false-negative results. The purpose of this study was to investigate the effects of EMLA (AstraZeneca) and lidocaine on common wound pathogenic bacteria. An in vitro study of a total of 25 clinical isolates and ATCC reference strains of Staphylococcus aureus (including methicillin-resistant S. aureus), Escherichia coli, Pseudomonas aeruginosa, and Streptococcus pyogenes was conducted. The isolates were exposed to the local anesthetic drugs (and some of their contents separately) at 35 degrees C over a 24-hour period and time-kill curves were recorded. No culture media were used and saline was used for controls. EMLA was found to have a rapid acting and powerful antibacterial effect and should not be used before culturing tissue samples. Lidocaine 1% was found not to inhibit the bacterial strains when exposure time was held below 2 hours. We conclude that culturing tissue from a wound biopsy is safe within 2 hours when a pure, preservative-free lidocaine 1% solution is used.
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Affiliation(s)
- Jais O Berg
- Department of Plastic Surgery, University Center of Wound Healing, Odense University Hospital, Odense, Denmark.
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Cassuto J, Sinclair R, Bonderovic M. Anti-inflammatory properties of local anesthetics and their present and potential clinical implications. Acta Anaesthesiol Scand 2006; 50:265-82. [PMID: 16480459 DOI: 10.1111/j.1399-6576.2006.00936.x] [Citation(s) in RCA: 206] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Development of new local anesthetic agents has been focused on the potency of their nerve-blocking effects, duration of action and safety and has resulted in a substantial number of agents in clinical use. It is well established and well documented that the nerve blocking effects of local anesthetics are secondary to their interaction with the Na+ channels thereby blocking nerve membrane excitability and the generation of action potentials. Accumulating data suggest however that local anesthetics also possess a wide range of anti-inflammatory actions through their effects on cells of the immune system, as well as on other cells, e.g. microorganisms, thrombocytes and erythrocytes. The potent anti-inflammatory properties of local anesthetics, superior in several aspects to traditional anti-inflammatory agents of the NSAID and steroid groups and with fewer side-effects, has prompted clinicians to introduce them in the treatment of various inflammation-related conditions and diseases. They have proved successful in the treatment of burn injuries, interstitial cystitis, ulcerative proctitis, arthritis and herpes simplex infections. The detailed mechanisms of action are not fully understood but seem to involve a reversible interaction with membrane proteins and lipids thus regulating cell metabolic activity, migration, exocytosis and phagocytosis.
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Affiliation(s)
- J Cassuto
- Department of Anesthesiology and Intensive Care and Institution of Surgical Specialties, Sahlgrenska University Hospital, Mölndal, Sweden.
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Abstract
AIM Lignocaine, a topical anaesthetic agent, is generally used in variable concentrations usually between 2% and 4% on the vocal cords prior to flexible bronchoscopy and bronchoalveolar lavage (BAL) procedures. The aim of this study was to investigate whether 2% or 1% lignocaine significantly inhibits the growth of organisms commonly found in the respiratory tract, in particular Streptococcus pneumoniae. METHOD In order to determine the antibiotic effect of lignocaine on lower respiratory tract flora, five different organisms were examined in vitro using well diffusion, disc diffusion and microbroth dilution against 1% and 2% concentrations of lignocaine. RESULTS Antimicrobial activity could not be detected using the well diffusion and the disc diffusion methods, as lignocaine failed to diffuse through the media. The microbroth dilution method showed reproducible bactericidal effect of these respiratory isolates against Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae at 2% concentration. Lignocaine 2% showed no growth inhibition against Pseudomonas aeruginosa and Candida albicans. Lignocaine 1% also partially inhibited S. pneumoniae. CONCLUSION As lignocaine shows significant inhibition of respiratory pathogens such as Streptococcus pneumoniae even at a concentration of 1%, the lowest concentration possible should be used for flexible bronchoscopy and BAL to maximise the chance of recovery of these organisms.
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Affiliation(s)
- Snehal S Chandan
- Division of Microbiology, Queensland Health Pathology Service, Royal Brisbane Women's Hospital, Herston, Queensland, Australia
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Erkert RS, Macallister CG, Campbell G, Payton ME, Shawley R, Clarke CR. Comparison of topical lidocaine/prilocaine anesthetic cream and local infiltration of 2% lidocaine for episioplasty in mares. J Vet Pharmacol Ther 2005; 28:299-304. [PMID: 15953204 DOI: 10.1111/j.1365-2885.2005.00657.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Local anesthesia and tissue inflammation associated with lidocaine infiltration and lidocaine/prilocaine topical anesthetic cream for episioplasty in mares were compared. Twenty-two mares were randomly assigned to lidocaine or lidocaine/prilocaine topical anesthetic cream treatment groups. Perineum and vulva were cleaned, 8-12 g (approximately 1 g/cm per side of vulva) of topical anesthetic cream was applied, and the area was covered by plastic wrap 30 min prior to beginning procedure. Alternately, lidocaine was injected (1 mL) every centimeter just prior to the procedure. Episioplasty was conducted using standard methods, but employing simple interrupted sutures. Horses were not sedated and use of a twitch was recorded. Four millimeter punch biopsies were harvested 1, 3, and 10 days following episioplasty and scored for degree of inflammation by a blinded pathologist. Clinical inflammation scores were assigned when biopsies were obtained. Seven of 11 horses receiving lidocaine infiltration required twitching, but none of the horses that received the anesthetic cream required twitching. Six of 11 and seven of 11 of the lidocaine and anesthetic cream groups, respectively, required twitching for episioplasty. Except for the clinical scores on day 3, no statistical differences for clinical and histopathologic scores between samples from the two treatment groups for a given day were identified. Use of lidocaine/prilocaine topical anesthetic cream was as effective as lidocaine infiltration in providing local anesthesia when performing episioplasty in mares. Its use decreased the need for twitching horses as well as the risk of deformation of the labia caused by lidocaine infiltration.
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Affiliation(s)
- R S Erkert
- Department of Physiological Sciences, Oklahoma State University, Stillwater, OK 74078, USA.
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Aucar JA, Bongera M, Phillips JO, Kamath R, Metzler MH. Quantitative tracheal lavage versus bronchoscopic protected specimen brush for the diagnosis of nosocomial pneumonia in mechanically ventilated patients. Am J Surg 2004; 186:591-6. [PMID: 14672763 DOI: 10.1016/j.amjsurg.2003.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND No gold standard method exists for the diagnosis of ventilator-associated pneumonia despite the availability of multiple techniques. METHODS A prospective, crossover study was performed on mechanically ventilated patients meeting with suspected pneumonia. Eighteen paired samples were obtained on 15 patients, comparing the results of quantitative tracheal lavage (QTL) to bronchoscopic protected brush specimen (PSB) by quantitative culture and gram stain examination. RESULTS The sensitivity, specificity, positive and negative predictive values, and accuracy are affected by the growth density threshold selected, and whether the same organisms are expected by both methods. There is a significant relationship between QTL and PSB (P = 0.0048; R = 0.632), gram stain and PSB (P <0.001; R = 0.791), and gram stain and QTL (P = 0.0125; R = 0.575), by Spearman rank order correlation. CONCLUSIONS QTL may have a role for diagnosing and directing treatment of ventilator-associated pneumonia, allowing reservation of bronchoscopic PSB for secondary, high risk and refractory cases.
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Affiliation(s)
- John A Aucar
- Division of General Surgery, Trauma and Critical Care, Department of Surgery, University of Missouri-Columbia, Columbia, MO 65212, USA.
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16
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Blanke W, Hallern BV. Sharp wound debridement in local anaesthesia using EMLA cream: 6 years' experience in 1084 patients. Eur J Emerg Med 2003; 10:229-31. [PMID: 12972901 DOI: 10.1097/00063110-200309000-00014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sharp debridement is the most efficient method for clearing the woundbed in the exudation and granulation phase of wound healing. At our clinic the anaesthetic lidocaine-prilocaine cream, EMLA, has been used as an analgesic for sharp debridement since 1994. A review of patients' records was conducted, including ulcer size, dose of cream used, analgesic efficacy and complications. During a 6-year period a total of 1084 patients were treated for leg ulcers, decubitus ulcers, abscess revisions, anal and coccyx fistulae, postoperative wounds, diabetic ulcers and burns. Doses ranging from 3 to 150 g cream were applied for 45-60 min. In all patients except three the analgesia was adequate for debridement. We observed no allergic reactions, no clinical symptoms of local anaesthetic toxicity or methaemoglobinaemia. In 12 patients (1.1%) a burning sensation was reported directly after the application of EMLA cream to the ulcer, which, however, subsided within 15-20 min. In our experience, sharp debridement in percutaneous analgesia with EMLA is efficient, economical, safe, and tolerable for the patient.
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Affiliation(s)
- Walter Blanke
- Department of Traumatology and Plastic Surgery, Elbe-Klinikum, Stade, Germany
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17
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Labetoulle M, Frau E, Offret H, Nordmann P, Naas T. Non-preserved 1% lidocaine solution has less antibacterial properties than currently available anaesthetic eye-drops. Curr Eye Res 2002; 25:91-7. [PMID: 12525962 DOI: 10.1076/ceyr.25.2.91.10159] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Some anaesthetics inhibit bacterial growth, and thus may lead to low rates of positive cultures from bacterial keratitis. Antibacterial properties of lidocaine were compared with those of oxybuprocaine or tetracaine, either in current commercial eye lotions or in extemporaneous solutions. METHODS Forty-eight bacterial strains were used to determine the minimum inhibitory and bactericidal concentrations of four commercial eye lotions containing oxybuprocaine or tetracaine, of a non-ophthalmic 1% lidocaine commercial solution and of extemporaneously prepared solutions of oxybuprocaine, tetracaine, lidocaine and benzalkonium. RESULTS Most strains had their growth inhibited by 0.2% oxybuprocaine or 0.4% tetracaine, which corresponds to a 1/2 dilution of the commercial eye-drops. Bacterial growth was still observed with a 1% lidocaine solution. CONCLUSIONS Currently available anaesthetic eye-drops that are used before corneal specimen collection may lead to false-negative bacterial cultures. Conversely, a non-preserved 1% lidocaine solution might be more appropriate in corneal specimen collection.
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Affiliation(s)
- Marc Labetoulle
- Department of Ophthalmology, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris-Sud, Paris, France
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18
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Halperin SA, McGrath P, Smith B, Houston T. Lidocaine-prilocaine patch decreases the pain associated with the subcutaneous administration of measles-mumps-rubella vaccine but does not adversely affect the antibody response. The journal The Journal of Pediatrics 2000. [DOI: 10.1016/s0022-3476(00)64169-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Olsen KM, Peddicord TE, Campbell GD, Rupp ME. Antimicrobial effects of lidocaine in bronchoalveolar lavage fluid. J Antimicrob Chemother 2000; 45:217-9. [PMID: 10660504 DOI: 10.1093/jac/45.2.217] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The antimicrobial activity of lidocaine in bronchoalveolar lavage fluid (BAL(f)) was investigated. Clinical respiratory isolates were added to BAL(f) suspensions containing lidocaine and to normal saline. The growth of two of four isolates of Streptococcus pneumoniae was significantly reduced in the presence of lidocaine-BAL(f) compared with controls in saline. Growth of Moraxella catarrhalis isolates was reduced in normal saline when compared with BAL(f) containing lidocaine. There was no effect upon the growth of Haemophilus influenzae, Pseudomonas aeruginosa and Candida albicans isolates. The recovery of isolates of S. pneumoniae may be reduced below the critical threshold of 10(5) cfu/mL during bronchoscopy when using lidocaine as a local anaesthetic.
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Affiliation(s)
- K M Olsen
- Department of Pharmacy Practice, University of Nebraska Medical Center, Omaha, NE 68198-6045, USA.
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21
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IS THE TUMESCENT SOLUTION BACTERIOCIDAL? Plast Reconstr Surg 1999. [DOI: 10.1097/00006534-199911000-00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Abstract
UNLABELLED Extrinsically contaminated propofol has been associated with multiple infectious complications. Injection of propofol is associated with pain that is diminished by the addition of lidocaine. Lidocaine has antibacterial properties at high concentrations, but low concentrations of lidocaine (0.1%) have not been studied. We examined the growth rates of Staphylococcus aureus, Serratia marcescens, Pseudomonas aeruginosa, and Candida albicans in propofol containing disodium edeteate with and without added lidocaine 0.1% 2, 5, and 24 h after inoculation. There was no significant difference in the number of colony-forming units between propofol with and without added lidocaine at any time after inoculation. IMPLICATIONS The addition of lidocaine to propofol in concentrations clinically effective in reducing pain on injection had no effect on microbial growth. Adherence to strict aseptic technique is further emphasized.
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Affiliation(s)
- M I Vidovich
- Department of Anesthesiology, Northwestern University Medical School, Chicago, Illinois, USA.
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24
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25
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Aldous WK, Jensen R, Sieck BM. Cocaine and Lidocaine with Phenylephrine as Topical Anesthetics: Antimicrobial Activity against Common Nasal Pathogens. EAR, NOSE & THROAT JOURNAL 1998. [DOI: 10.1177/014556139807700713] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Wade K. Aldous
- Department of Clinical Investigation, Otolaryngological Service, Madigan Army Medical Center, Tacoma, Washington
| | - Ray Jensen
- Department of Surgery, Otolaryngological Service, Madigan Army Medical Center, Tacoma, Washington
| | - Brian M. Sieck
- Department of Surgery, Otolaryngological Service, Madigan Army Medical Center, Tacoma, Washington
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26
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Williams BJ, Hanke CW, Bartlett M. Antimicrobial effects of lidocaine, bicarbonate, and epinephrine. J Am Acad Dermatol 1997; 37:662-4. [PMID: 9344216 DOI: 10.1016/s0190-9622(97)70195-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- B J Williams
- Department of Dermatology, Indiana University Medical Center, Indianapolis 46202, USA
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27
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Invasive Techniques for the Diagnosis of Respiratory Infectious Diseases. J Infect Chemother 1996; 1:166-176. [PMID: 29681359 DOI: 10.1007/bf02350644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/1996] [Accepted: 12/21/1996] [Indexed: 10/24/2022]
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28
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Pozzi E, Masiero P, Oliva A. Evaluation of the invasive techniques for diagnosing bacterial respiratory infections. J Chemother 1995; 7:286-91. [PMID: 8568540 DOI: 10.1179/joc.1995.7.4.286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Bacterial community-acquired respiratory infections are usually sustained by strains highly responsive to antibiotic therapy. Thus, the clinical approach is based on an empirical treatment and does not require the isolation of the causative pathogen and the determination of the bacterial susceptibility to antibiotics. On the other hand, Gram-negative bacteria, most commonly multidrug resistant, frequently affect immunocompromised and nosocomial patients and their identification in cultures is absolutely necessary for proper antibacterial treatment. To this aim, two conventional methods are used, i.e. the blood culture, which is positive only in 20% of pneumonia cases, and the sputum culture, which is not invasive but easily contaminated by oropharyngeal flora. Consequently, invasive techniques for sampling the pathologic specimen, such as the BAL and the PSB, performed with the help of fiberoptic bronchoscope, are needed. The diagnostic power and the limits of both these techniques are analyzed. Moreover, the opportunity to obtain quantitative cultures, which may discriminate between contamination and infection is considered.
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Affiliation(s)
- E Pozzi
- Clinical and Biological Sciences Department, University of Turin, Italy
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29
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Abstract
Lower respiratory tract infections are characterized by significant morbidity and mortality but also by a relative inability to establish a specific etiologic agent on clinical grounds alone. With the recognized shortcomings of expectorated or aspirated secretions toward establishing an etiologic diagnosis, clinicians have increasingly used bronchoscopy to obtain diagnostic samples. A variety of specimen types may be obtained, including bronchial washes or brushes, protected specimen brushings, bronchoalveolar lavage, and transbronchial biopsies. Bronchoscopy has been applied in three primary clinical settings, including the immunocompromised host, especially human immunodeficiency virus-infected and organ transplant patients; ventilator-associated pneumonia; and severe, nonresolving community- or hospital-acquired pneumonia in nonventilated patients. In each clinical setting, and for each specimen type, specific laboratory protocols are required to provide maximal information. These protocols should provide for the use of a variety of rapid microscopic and quantitative culture techniques and the use of a variety of specific stains and selective culture to detect unusual organism groups.
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Affiliation(s)
- V S Baselski
- Department of Pathology, University of Tennessee, Memphis 38163
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30
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Fisher DA. Recurrent cellulitis. J Am Acad Dermatol 1994; 30:675-6. [PMID: 8157808 DOI: 10.1016/s0190-9622(09)80133-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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31
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Thompson KD, Welykyj S, Massa MC. Antibacterial activity of lidocaine in combination with a bicarbonate buffer. THE JOURNAL OF DERMATOLOGIC SURGERY AND ONCOLOGY 1993; 19:216-20. [PMID: 8383149 DOI: 10.1111/j.1524-4725.1993.tb00339.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The antibacterial properties of lidocaine have been previously described. Recent reports indicated that the addition of NaHCO3 to lidocaine reduces the pain associated with the injection. This study was conducted to determine the antibacterial activity of lidocaine buffered with NaHCO3. METHODS Rates of killing of six species of bacteria were determined in the presence of buffered and unbuffered lidocaine. When bacteria were incubated with lidocaine buffered with NaHCO3 at either 25, 50, or 100 mEq/L, there was a decrease of > 99% of all bacteria tested over the 6 hours of the assay. This dramatic rate of killing was not observed in the unbuffered control preparations. RESULTS The results of this study indicate that NaHCO3 enhances the killing effect that has been described for lidocaine alone. The inability to recover common pathogenic bacteria from biopsy specimens could be the result of exposure to local anesthetic agents such as lidocaine that are buffered with NaHCO3.
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Affiliation(s)
- K D Thompson
- Department of Pathology and Microbiology, Loyola University Medical Center, Maywood, Illinois 60153
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32
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Dotson RG, Pingleton SK. The effect of antibiotic therapy on recovery of intracellular bacteria from bronchoalveolar lavage in suspected ventilator-associated nosocomial pneumonia. Chest 1993; 103:541-6. [PMID: 8432151 DOI: 10.1378/chest.103.2.541] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Intracellular bacteria (ICB) within recovered cells (> 7 percent) obtained via bronchoalveolar lavage (BAL) have been described as predictive of subsequent positive quantitative protected specimen brush (PSB) cultures in patients not receiving antibiotics. To determine the effect of prior or current antibiotic therapy on ICB relative to subsequent PSB culture, we prospectively evaluated 49 consecutive episodes of clinically suspected ventilator-associated pneumonia in 36 patients. Three patient groups were defined based on antibiotic administration: group 1 (current antibiotics), n = 31, samples obtained from patients currently receiving antibiotics; group 2 (recent antibiotics), n = 5, samples obtained from patients who received antibiotics > 48 h but < 72 h prior to sampling; and group 3 (no antibiotics), n = 13, samples from patients receiving no previous antibiotics within 7 days prior to sampling. Overall, PSB cultures (> or = 10(3) cfu/ml) were positive in 14 of 49 (29 percent) samples. In group 1, 2 of 31 (6 percent) samples were positive while 5 of 5 (100 percent) samples in group 2, and 7 of 13 (54 percent) in group 3 were positive. The presence or absence of ICB accurately predicted both positive and negative PSB cultures in 43 of 49 episodes. Of 43 correct predictions, 34 were negative predictions (negative ICB, negative PSB culture). The vast majority of these (29) were obtained from group 1, patients currently receiving antibiotics. In contrast, of nine positive predictions (+ICB, +PSB) virtually all (seven) occurred in group 3, patients receiving no antibiotics. In group 3, 13 of 13 PSB cultures were accurately predicted, either positive or negative, by the presence or absence of ICB. Of seven positive PSB cultures in groups 1 and 2, only 2 (28 percent) were accurately predicted by ICB. From both samples, the cultured organism was resistant to all administered antibiotics. These data suggest both prior and current antibiotic therapy reduces recovery of ICB from BAL and reduces predictive accuracy of ICB for subsequent positive PSB cultures. However, negative prediction by ICB for subsequent negative PSB cultures was good. In contrast, ICB obtained from patients not receiving antibiotics are highly predictive of subsequent PSB culture results, both positive and negative. We do not recommend BAL for evaluation of ICB in patients currently receiving antibiotics or with a recent history of antibiotic use.
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Affiliation(s)
- R G Dotson
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City
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33
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Meduri GU, Chastre J. The standardization of bronchoscopic techniques for ventilator-associated pneumonia. Chest 1992; 102:557S-564S. [PMID: 1424930 DOI: 10.1378/chest.102.5_supplement_1.557s] [Citation(s) in RCA: 205] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- G U Meduri
- Division of Pulmonary and Critical Care Medicine, University of Tennessee, Memphis
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34
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Meduri GU, Chastre J. The Standardization of Bronchoscopic Techniques for Ventilator-Associated Pneumonia. Infect Control Hosp Epidemiol 1992. [DOI: 10.2307/30147007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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35
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Broughton WA, Middleton RM, Kirkpatrick MB, Bass JB. Bronchoscopic Protected Specimen Brush and Bronchoalveolar Lavage in the Diagnosis of Bacterial Pneumonia. Infect Dis Clin North Am 1991. [DOI: 10.1016/s0891-5520(20)30399-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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36
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37
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Powell DM, Rodeheaver GT, Foresman PA, Hankins CL, Bellian KT, Zimmer CA, Becker DG, Edlich RF. Damage to tissue defenses by EMLA cream. J Emerg Med 1991; 9:205-9. [PMID: 1861053 DOI: 10.1016/0736-4679(91)90414-b] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
EMLA is a new topical agent that safely anesthetizes intact skin. The purpose of this study was to determine if this cream could be safely used for anesthetizing wounds. This investigation evaluated the potential toxicity of EMLA cream in wounds by measuring its effect on host defenses and on the biology of wound repair. In contaminated wounds, EMLA cream elicited an exaggerated inflammatory response that damaged host defenses, inviting the development of infection. As a result of these investigations, we do not recommend the use of EMLA cream in wounds.
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Affiliation(s)
- D M Powell
- Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville
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38
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Zenilman JM, Reichart CA, Neumann TM, Hook EW. Cocaine hydrochloride and benzoylecgonine have no in vitro inhibitory effect against Neisseria gonorrhoeae. Antimicrob Agents Chemother 1991; 35:1228-9. [PMID: 1929267 PMCID: PMC284316 DOI: 10.1128/aac.35.6.1228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We evaluated 72 clinical Neisseria gonorrhoeae isolates for in vitro susceptibility to cocaine hydrochloride and its metabolite benzoylecgonine and to penicillin, tetracycline, erythromycin, ceftriaxone, and ofloxacin. Although there was a wide range of susceptibilities to the antimicrobial agents, cocaine and its major metabolite, benzoylecgonine, had no demonstrable antigonococcal activity. Cocaine use is frequently associated with outbreaks of sexually transmitted disease. We hypothesized that the dramatically decreasing incidence of gonorrhea over the past 15 years may be in part due to pharmacological effects of cocaine. However, since cocaine and its metabolite have no in vitro antigonococcal activity, this hypothesis is unlikely.
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Affiliation(s)
- J M Zenilman
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
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39
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Malabonga VM, Basti J, Kamholz SL. Utility of bronchoscopic sampling techniques for cryptococcal disease in AIDS. Chest 1991; 99:370-2. [PMID: 1989797 DOI: 10.1378/chest.99.2.370] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although cryptococcal pneumonia is a well recognized complication of the acquired immunodeficiency syndrome, optimal diagnostic approaches remain to be defined. During a 32-month period (October 1984 to June 1987), 11 patients were diagnosed with CP at our institution. The diagnosis was established in all 11 patients from specimens obtained via fiberoptic bronchoscopy (ten) and/or double-lumen catheter lavage (one). Direct stains of sedimented bronchoalveolar lavage were positive for organisms characteristic of Cryptococcus neoformans in nine of 11 patients. Transbronchial biopsies were positive (special histologic stains) in six of eight patients; bronchial washings were positive (direct smear) in seven of ten patients, the bronchial brushings were positive on stain in six of nine patients, and in one patient, a Wang transbronchial needle aspirate was positive on stain. Fungal cultures were positive on the BAL in seven of 11 patients, and on the bronchial washings in four of ten patients; the TBBx culture samples were all negative (zero of three). The serum cryptococcal antigen titer was elevated (median = 1:1024) in all eight patients in which it was assayed. Our data suggest that BAL and bronchial washings have a combined sensitivity on smear equal to that of TBBx and superior to that of TBBx fungal culture. The TBBx does not appear to be necessary in this setting. In addition, an elevated serum cryptococcal antigen titer appears to be an important adjunct in the evaluation of pulmonary infiltrates in AIDS.
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Affiliation(s)
- V M Malabonga
- Department of Medicine, State University of New York, Brooklyn 11203-2098
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40
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Ortqvist A, Kalin M, Lejdeborn L, Lundberg B. Diagnostic fiberoptic bronchoscopy and protected brush culture in patients with community-acquired pneumonia. Chest 1990; 97:576-82. [PMID: 2306961 DOI: 10.1378/chest.97.3.576] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A model for performing fiberoptic bronchoscopy as a supplement to noninvasive diagnostic methods, in patients with community-acquired pneumonia, was prospectively studied. Twenty-four patients underwent bronchoscopy, seven pilot patients and 17 of 277 (6 percent) consecutive patients with CAP. Indications for FOB were early therapy failure (less than or equal to 72h)(n = 7), late therapy failure (greater than 72h)(n = 11), or before start of antibiotic therapy in severely ill or immunocompromised patients (n = 6). Samples were obtained by aspiration of bronchial secretion and with a protected brush catheter from which quantitative cultures with a detection level of 10(4) colony forming units per ml were performed. Results concluded that FOB, with the use of quantitative PB-cultures, offered a safe and specific diagnostic tool, which on special indications, can be of great value in the management of patients with CAP.
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Affiliation(s)
- A Ortqvist
- Department of Infectious Diseases, Karolinska Institute, Stockholm, Sweden
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41
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Schlapbach P, Ambord C, Blöchlinger AM, Gerber NJ. Bacterial arthritis: are fever, rigors, leucocytosis and blood cultures of diagnostic value? Clin Rheumatol 1990; 9:69-72. [PMID: 2335053 DOI: 10.1007/bf02030245] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Clinical suspicion, positive gram stains and cultures of the synovial fluid are the fundamental criteria for the diagnosis of bacterial arthritis. Bacterial arthritis may, however, show an oligosymptomatic clinical course and thus lead to a delay in diagnosis. The case records of 43 patients with bacterial arthritis were reviewed retrospectively. Rigors (20.9%), fever (40.5%), blood leucocytosis (41.8%) and a shift to the left of blood leucocytes (35%) were found in less than half of all examined patients. Positive cultures of the synovial fluid (71.4%) were far more frequent than positive blood cultures (23.5%). We conclude, that the absence of fever, rigors, blood leucocytosis and positive blood cultures does not rule out the possibility of bacterial arthritis.
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Affiliation(s)
- P Schlapbach
- Department of Rheumatology, University of Bern, Inselspital, Switzerland
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42
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43
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Dorca J. Tecnicas invasivas en el diagnostico de las neumonias. Arch Bronconeumol 1989. [DOI: 10.1016/s0300-2896(15)31692-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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44
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45
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Berger R, McConnell JW, Phillips B, Overman TL. Safety and efficacy of using high-dose topical and nebulized anesthesia to obtain endobronchial cultures. Chest 1989; 95:299-303. [PMID: 2914478 DOI: 10.1378/chest.95.2.299] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
We evaluated the safety and efficacy of high-dose topical and nebulized airway anesthesia in normal volunteers and in patients undergoing diagnostic fiberoptic bronchoscopy. Lidocaine solution (4 percent) was used for gargling, for spraying the palate and oropharynx with an atomizer, and for nebulization with an air-powered nebulizer (mean total dose, 1,682 mg) and 2 percent lidocaine (Xylocaine) jelly for anesthetizing nasal passages. In six normal subjects and in eight patients, lidocaine blood levels were measured at baseline, after gargling, after spraying, after nebulization, and then at 5, 10, 15, 30, and 60 min; 19 normal subjects and ten patients underwent the same anesthesia protocol but had no blood drawn. Fiberoptic bronchoscopy was performed in 21 normal volunteers and in 18 patients and cultures obtained using the protected specimen brush. Additional endobronchial lidocaine (mean 256 mg) was given to the 18 patients after collecting the microbiology specimens. Peak lidocaine blood levels remained below 6 micrograms/ml in all cases. Cough and discomfort during bronchoscopic examination was absent or minimal in 17 of 21 normal subjects (80 percent) and in 14 of 18 patients (77 percent) and was severe in only one instance (5 percent). There were no related complications. Using only topical and nebulized anesthesia is safe and effective for performing fiberoptic bronchoscopy, especially when bacterial cultures are to be obtained and endobronchial instillation of lidocaine must be avoided.
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Affiliation(s)
- R Berger
- Division of Pulmonary and Critical Care Medicine, Veterans Administration, Lexington, KY 40511
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46
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48
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49
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Glanville AR, Marlin GE, Hartnett BJ, Yap JM, Bradbury R. The use of fibreoptic bronchoscopy with sterile catheter in the diagnosis of pneumonia. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1985; 15:309-19. [PMID: 3864423 DOI: 10.1111/j.1445-5994.1985.tb04043.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The use of fibreoptic bronchoscopy with sterile catheter sampling of pulmonary secretions was evaluated in 70 patients with a provisional diagnosis of pneumonia. In 37 patients quantitative analysis of the sterile catheter isolates was performed (colony forming units (CFU) per ml). Potential bacterial pathogens were isolated in 37 patients and in the quantitative analysis, 14 of 22 isolates were grown in counts greater than or equal to 10(3) CFU/ml. Sterile catheter increased the bacterial isolation rate as in only 19 patients blood (2) or sputum (18) cultures yielded the same organisms. Sputum cultures showed a 25% false-positive rate in patients with no growth from sterile catheter. Quantitative analysis did not yield any further information in patients receiving antibiotics. Atypical or fungal pneumonia was diagnosed in 22 patients, while ten patients had other pathology simulating pneumonia. Sterile catheter sampling of pulmonary secretions at fibreoptic bronchoscopy proved to be a valuable tool in the diagnosis of bacterial pneumonia.
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Bass JB, Hawkins EL, Bonner JR, Pollock HM. Use of a bronchoscopic protected catheter technique in the clinical evaluation of a new antibiotic. Diagn Microbiol Infect Dis 1983; 1:95-106. [PMID: 6370562 DOI: 10.1016/0732-8893(83)90038-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We prospectively compared the usefulness of a bronchoscopic protected catheter technique with the results from sputum cultures in the evaluation of moxalactam, a new beta-lactam antibiotic. The significance of a given isolate on protected catheter culture was determined by quantitative bacteriology. 32 patients with community-acquired pneumonia were enrolled in the study and 31 grew common lower respiratory tract pathogens from their protected catheter specimen. The most common single pathogens recovered were Streptococcus pneumoniae (11 patients) and Haemophilus influenzae (2). Mixed flora, predominantly anaerobes, were isolated from 15 patients, and 3 patients had mixed aerobic infections. All seven bacteremic cases had the identical organism isolated from the protected catheter specimen, confirming the accuracy of the technique. Comparisons with sputum cultures showed that the predominant organism on sputum culture was the same as that obtained from the protected catheter culture in only 13% of the cases. Sputum cultures revealed either no pathogen or a different pathogen in 23 cases, and no sputum could be obtained in 4. Compared to cultures of expectorated sputum, we found the protected catheter bronchoscopic culture technique to have the following advantages in the bacteriologic evaluation of moxalactam: 1) greater accuracy and sensitivity in bacteremic patients; 2) accurate delineation of the bacteriology of infections; and 3) a higher percentage of patients with evaluable bacteriology leading to greater efficiency during the investigation.
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