SummaryThis paper reports our experience in monitoring gentamicin therapy during the treatment of 68 episodes of serious Gramnegative sepsis in 65 hospital patients. Most of the patients had major underlying disease. Of those who were adequately treated (peak serum concentrations of 5 ,ug/ml or more in 72 hours for septicaemia, urinary tract infection, and wound infection; and 8 ,ug/ml or more at some time during the course of treatment for pneumonia) B4% (46 out of 55) were cured. These serum concentrations could be achieved only by starting with a regimen of 5 mg/kg/day in three divided doses in ali adult patients, subsequent dosage being determined by the results of rapid serum assay. The incidence of nephrotoxicity and symptomatic ototoxicity was no greater than in previous series. The main reason for assaying serum gentamicin is to ensure that an adequate dosage is achieved as soon as possible. In patients with impaired renal function or receiving prolonged high dosage assays also serve to guard against an excessive accumulation of gentamicin and an increased risk of toxicity.

No abstract

Aims To evaluate the incidence of line infections in a UK paediatric oncology centre and assess the efficacy of biopatch (a chlorhexidine impregnated exit site patch applied at line insertion) at reducing infections. Introduction Central venous access is an essential component of paediatric oncology care however line insertion requires general anaesthesia and infections can be life threatening. Novel strategies to reduce line infections therefore merit evaluation. Methods We audited the incidence of line infections before and after the introduction of biopatch. Data was collected retrospectively from electronic theatre records and hospital results systems over an 18 month period and each line was followed up for 6 months. We also investigated whether neutropaenia at insertion was associated with infection (chi-square test). Results First six months (before biopatch): 45 patients had 64 lines inserted (1.42 per patient). 12 lines (19%) were removed due to proven infection. There were 9 exit site infections (0.14 per line) and 1 line was removed due to exit site infection alone. There were 33 blood culture positive infections (0.52 per line). Second six months (before biopatch): 47 patients had 52 lines inserted (1.11 per patient). 7 (13%) were removed due to proven infection. There were 18 exit site infections (0.35 per line) and 2 were removed as a result of this alone. There were 19 blood culture positive infections (0.37 per line). Third six months (post biopatch introduction): 45 patients had 52 lines inserted (1.15 per patient). 15 (28%) were removed due to proven infection. There was 1 exit site infection (0.02 per line) and no lines were removed on the basis of this alone. There were 37 blood culture positive infections (0.71 per line). In all time periods there was no association between neutropaenia (<0.5 x 109/L) at the time of insertion and subsequent line infection (P = 0.71). Conclusion Introducing biopatch reduced the number of exit site infections. There was no reduction in blood culture positive infections. There was no association between neutropaenia at the time of line insertion and subsequent line infection.