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"Davies, Robert"
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Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010
Historical perspective The Egyptian physician Imhotep initially described pleural infection around 3000 BC, although Hippocrates has been more famously credited with its recognition in 500 BC. [...]the 19th century open thoracic drainage was the recommended treatment for this disorder but carried an associated mortality of up to 70%. Age-adjusted incidence rates also increased in their cohort by almost 13% during the 8-year period. 3 Risk factors for pleural infection mirror those for pneumonia although independent considerations for developing empyema include diabetes mellitus, immunosuppression including corticosteroid use, gastro-oesophageal reflux, alcohol misuse and intravenous drug abuse. 2 A history of aspiration or poor oral hygiene is often elicited in anaerobic infection.
Journal Article
Truck stuck
Illustrations and simple rhyming text tell the story of a big truck that gets stuck under a bridge.
Book
Intrapleural Use of Tissue Plasminogen Activator and DNase in Pleural Infection
Slowly clearing infections in the pleural space are a source of substantial morbidity. This study showed that instillation of recombinant DNase and tissue plasminogen activator (t-PA) is more effective than placebo in clearing radiographic pleural effusions.
Pleural infection affects more than 65,000 patients each year in the United States and the United Kingdom,
1
and the incidence is increasing in both countries — in both children
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–
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and adults.
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,
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The mortality rate from pleural infection is between 10% and 20%,
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,
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–
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and drainage through a chest tube and administration of antibiotics fail in approximately one third of patients, who then require surgical drainage.
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,
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The median duration of the hospital stay for these patients is 12 to 15 days,
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,
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,
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,
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with 25% hospitalized for more than a month. Care of each patient costs . . .
Journal Article
Clothesline clues to the first day of school
\"Catchy rhymes and visual cues introduce young readers to the people they meet on their first day of school. The clues in each lively verse can be spotted hanging from the clotheslines.\"-- Publisher's description.
Book
Co-Selection of Resistance to Antibiotics, Biocides and Heavy Metals, and Its Relevance to Foodborne Pathogens
Concerns have been raised in recent years regarding co-selection for antibiotic resistance among bacteria exposed to biocides used as disinfectants, antiseptics and preservatives, and to heavy metals (particularly copper and zinc) used as growth promoters and therapeutic agents for some livestock species. There is indeed experimental and observational evidence that exposure to these non-antibiotic antimicrobial agents can induce or select for bacterial adaptations that result in decreased susceptibility to one or more antibiotics. This may occur via cellular mechanisms that are protective across multiple classes of antimicrobial agents or by selection of genetic determinants for resistance to non-antibiotic agents that are linked to genes for antibiotic resistance. There may also be relevant effects of these antimicrobial agents on bacterial community structure and via non-specific mechanisms such as mobilization of genetic elements or mutagenesis. Notably, some co-selective adaptations have adverse effects on fitness in the absence of a continued selective pressure. The present review examines the evidence for the significance of these phenomena, particularly in respect of bacterial zoonotic agents that commonly occur in livestock and that may be transmitted, directly or via the food chain, to human populations.
Journal Article
Clothesline clues to sports people play
Using the image of uniforms and equipment hanging on a clothesline, the text invites children to identify the sport played by each child.
Book
Blood culture bottle culture of pleural fluid in pleural infection
BackgroundPleural infection is common, and has a >30% major morbidity and mortality—particularly when infection is caused by Gram-negative, Staphylococcus aureus or mixed aerobic pathogens. Standard pleural fluid culture is negative in ∼40% of cases. Culturing pleural fluid in blood culture bottles may increase microbial yield, and is cheap and easy to perform.ObjectivesTo determine whether inoculating pleural fluid into blood culture bottles increases the culture positivity of pleural infection over standard laboratory culture, and to assess the optimum volume of inoculum to introduce.Methods62 patients with pleural infection were enrolled. Pairs of aerobic and anaerobic blood culture bottles were inoculated at the bedside with 2, 5 or 10 ml of pleural fluid, and two pleural fluid specimens were sent for standard culture. Pleural fluid from nine control patients was cultured to test for ‘false-positive’ results.ResultsThe addition of blood culture bottle culture to standard culture increased the proportion of patients with identifiable pathogens by 20.8% (20/53 (37.7%) to 31/53 (58.5%) (difference 20.8%, 95% CI difference 8.9% to 20.8%, p<0.001)). The second standard culture did not similarly improve the culture positivity (19/49 (38.8%) to 22/49 (44.9%) (difference 6.1%, 95% CI difference −2.5% to 6.1%, p=0.08)). The culture inoculum volume did not influence bacterial isolation frequency. The control fluids were culture negative.ConclusionsBlood culture bottle culture of infected pleural fluid increases microbial yield when used in addition to standard culture. This technique should be part of routine care.
Journal Article
U.K. Controlled Trial of Intrapleural Streptokinase for Pleural Infection
In this randomized trial involving 454 patients with pleural infections that required antibiotic therapy and chest-tube drainage, there was no benefit from the use of intrapleural streptokinase in terms of survival, the need for surgery, the length of the hospital stay, or the resolution of radiographic abnormalities.
In this trial involving 454 patients with pleural infections, there was no benefit from the use of intrapleural streptokinase in terms of survival, the need for surgery, the length of the hospital stay, or the resolution of radiographic abnormalities.
Pleural infection develops in about 65,000 patients each year in the United States and the United Kingdom.
1
Approximately 15 percent of patients die,
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which is similar to the death rate among patients hospitalized with pneumonia,
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,
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and 15 to 40 percent require surgical drainage of the infected pleural space.
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,
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The median duration of inpatient care is 15 days, with 20 percent of patients remaining in the hospital for a month or longer.
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Apart from antibiotic therapy, treatment in patients with pleural infection consists mainly of drainage of the infected pleural fluid, and the intrapleural administration of fibrinolytic drugs is . . .
Journal Article