Study ObjectivesMass gathering event medical staffing requires coordination of limited resources to provide effective care to participants, spectators, and the host city's general population. When medical assets are dispatched to a scene of a medical emergency, this limited resource is taken out of service for any other use. Due to the nature of planned mass gathering events, multiple crews may be dispatched to care for the same patient or to a scene where a patient has eloped or is not found. When this occurs, redundancy of resource allocation is created. Race planners must anticipate such redundancy when staffing medical resources, but to our knowledge, expected rates for duplicate ambulance dispatch and patient-not-found calls have not been reported for a large planned mass gathering event. This study sought to describe the rates of duplicate ambulance dispatch and patient-not-found calls at a large marathon over 3 consecutive years.MethodsThis study describes a retrospective, observational review of ambulance dispatch logs from the Bank of America Chicago Marathon from 2008-2010. The Chicago Marathon is a large annual urban marathon where approximately 45,000 participants and 1.3 million spectators are gathered. Dispatch records from the Central Medical Dispatch/Unified Command of the marathon were obtained, and inclusion criteria included all calls for medical assistance. Runs listed as “Duplicate Call” and “Patient Not Found” were identified. Descriptive analysis was performed.ResultsA total of 1050 calls were received to Central Medical Dispatch over the study period: 395, 137, and 518 respectively in years 2008-2010. The overall duplicate call rate was 8.0%, with a trend toward a higher rate (12.4%) during the cool weather year of 2009. The aggregate patient-not-found rate was 18.4%. Warm weather years with a higher overall call volume resulted in a higher patient-not-found rate: 14.2% in 2008 and 24.3% in 2010. Together, these 2 types of calls comprised 26.3% of all ambulance dispatches over the study period.ConclusionAlthough not always avoidable, duplicate emergency medical system (EMS) runs and dispatches to scenes without patients found consume significant resources at mass gathering events. Knowing the rates of these dispatches can help mass gathering event organizers staff medical assets appropriately and can also promote efforts to minimize their occurrences. Even at the Bank of America Chicago Marathon where a sophisticated Unified Central Command coordinates city and private EMS assets to efficiently utilize ambulance resources, duplicate dispatches and patient-not-found calls occur once in every 4 dispatches. Further studies can investigate the effect of weather conditions on these rates, as a trend toward variable rates based on weather was observed. Accounting for an expected amount of redundancy in ambulance dispatches during an event's planning process may inform medical staffing and promote rapid response to all dispatches during a large urban planned mass gathering event. Study ObjectivesMass gathering event medical staffing requires coordination of limited resources to provide effective care to participants, spectators, and the host city's general population. When medical assets are dispatched to a scene of a medical emergency, this limited resource is taken out of service for any other use. Due to the nature of planned mass gathering events, multiple crews may be dispatched to care for the same patient or to a scene where a patient has eloped or is not found. When this occurs, redundancy of resource allocation is created. Race planners must anticipate such redundancy when staffing medical resources, but to our knowledge, expected rates for duplicate ambulance dispatch and patient-not-found calls have not been reported for a large planned mass gathering event. This study sought to describe the rates of duplicate ambulance dispatch and patient-not-found calls at a large marathon over 3 consecutive years. Mass gathering event medical staffing requires coordination of limited resources to provide effective care to participants, spectators, and the host city's general population. When medical assets are dispatched to a scene of a medical emergency, this limited resource is taken out of service for any other use. Due to the nature of planned mass gathering events, multiple crews may be dispatched to care for the same patient or to a scene where a patient has eloped or is not found. When this occurs, redundancy of resource allocation is created. Race planners must anticipate such redundancy when staffing medical resources, but to our knowledge, expected rates for duplicate ambulance dispatch and patient-not-found calls have not been reported for a large planned mass gathering event. This study sought to describe the rates of duplicate ambulance dispatch and patient-not-found calls at a large marathon over 3 consecutive years. MethodsThis study describes a retrospective, observational review of ambulance dispatch logs from the Bank of America Chicago Marathon from 2008-2010. The Chicago Marathon is a large annual urban marathon where approximately 45,000 participants and 1.3 million spectators are gathered. Dispatch records from the Central Medical Dispatch/Unified Command of the marathon were obtained, and inclusion criteria included all calls for medical assistance. Runs listed as “Duplicate Call” and “Patient Not Found” were identified. Descriptive analysis was performed. This study describes a retrospective, observational review of ambulance dispatch logs from the Bank of America Chicago Marathon from 2008-2010. The Chicago Marathon is a large annual urban marathon where approximately 45,000 participants and 1.3 million spectators are gathered. Dispatch records from the Central Medical Dispatch/Unified Command of the marathon were obtained, and inclusion criteria included all calls for medical assistance. Runs listed as “Duplicate Call” and “Patient Not Found” were identified. Descriptive analysis was performed. ResultsA total of 1050 calls were received to Central Medical Dispatch over the study period: 395, 137, and 518 respectively in years 2008-2010. The overall duplicate call rate was 8.0%, with a trend toward a higher rate (12.4%) during the cool weather year of 2009. The aggregate patient-not-found rate was 18.4%. Warm weather years with a higher overall call volume resulted in a higher patient-not-found rate: 14.2% in 2008 and 24.3% in 2010. Together, these 2 types of calls comprised 26.3% of all ambulance dispatches over the study period. A total of 1050 calls were received to Central Medical Dispatch over the study period: 395, 137, and 518 respectively in years 2008-2010. The overall duplicate call rate was 8.0%, with a trend toward a higher rate (12.4%) during the cool weather year of 2009. The aggregate patient-not-found rate was 18.4%. Warm weather years with a higher overall call volume resulted in a higher patient-not-found rate: 14.2% in 2008 and 24.3% in 2010. Together, these 2 types of calls comprised 26.3% of all ambulance dispatches over the study period. ConclusionAlthough not always avoidable, duplicate emergency medical system (EMS) runs and dispatches to scenes without patients found consume significant resources at mass gathering events. Knowing the rates of these dispatches can help mass gathering event organizers staff medical assets appropriately and can also promote efforts to minimize their occurrences. Even at the Bank of America Chicago Marathon where a sophisticated Unified Central Command coordinates city and private EMS assets to efficiently utilize ambulance resources, duplicate dispatches and patient-not-found calls occur once in every 4 dispatches. Further studies can investigate the effect of weather conditions on these rates, as a trend toward variable rates based on weather was observed. Accounting for an expected amount of redundancy in ambulance dispatches during an event's planning process may inform medical staffing and promote rapid response to all dispatches during a large urban planned mass gathering event. Although not always avoidable, duplicate emergency medical system (EMS) runs and dispatches to scenes without patients found consume significant resources at mass gathering events. Knowing the rates of these dispatches can help mass gathering event organizers staff medical assets appropriately and can also promote efforts to minimize their occurrences. Even at the Bank of America Chicago Marathon where a sophisticated Unified Central Command coordinates city and private EMS assets to efficiently utilize ambulance resources, duplicate dispatches and patient-not-found calls occur once in every 4 dispatches. Further studies can investigate the effect of weather conditions on these rates, as a trend toward variable rates based on weather was observed. Accounting for an expected amount of redundancy in ambulance dispatches during an event's planning process may inform medical staffing and promote rapid response to all dispatches during a large urban planned mass gathering event.

Background: Although antibiotic prophylaxis against infective endocarditis is recommended, the true risk factors for infective endocarditis are unclear.Objective: To quantitate the risk for endocarditis from dental treatment and cardiac abnormalities.Design: Population-based, case-control studySetting: 54 hospitals in the Philadelphia area.Patients: Persons with community-acquired infective endocarditis not associated with intravenous drug use were compared with community residents, matched by age, sex, and neighborhood of residence.Measurements: Information on demographic characteristics, host risk factors, and dental treatment was obtained from structured telephone interviews, dental records, and medical records.Results: During the preceding 3 months, dental treatment was no more frequent among case-patients than controls (adjusted odds ratio, 0.8 [95% CI, 0.4 to 1.5]). Of 273 case-patients, 104 (38%) knew of previous cardiac lesions compared with 17 controls (6%) (adjusted odds ratio, 16.7 [Cl, 7.4 to 37.4]). Case-patients more often had a history of mitral valve prolapse (adjusted odds ratio, 19.4 [Cl, 6.4 to 58.4]), congenital heart disease (adjusted odds ratio, 6.7 [Cl, 2.3 to 19.4]), cardiac valvular surgery (adjust ed odds ratio 74.6 [CI, 12.5 to 447]), rheumatic fever (adjusted odds ratio, 13.4 [CI, 4.5 to 39.5]), and heart murmur without other known cardiac abnormalities (adjusted odds ratio, 4.2 [CI, 2.0 to 8.9]). Among case-patients with known cardiac lesions-the target of prophylaxis - dental therapy was significantly (P = 0.03) less common than among controls (adjusted odds ratio, 0.2 [Cl, 0.04 to 0.7] over 3 months). Few participants received prophylactic antibiotics.Conclusions: Dental treatment does not seem to be a risk factor for infective endocarditis, even in patients with valvular abnormalities, but cardiac valvular abnormalities are strong risk factors. Few cases of infective endocarditis would be preventable with antibiotic prophylaxis, even with 100% effectiveness assumed. Current policies for prophylaxis should be reconsidered.

The activity of RP 59500 (quinupristin/dalfopristin) was evaluated in vitro against antibiotic-resistant strains of Streptococcus pneumoniae (N = 15) and Enterococcus spp. (N = 43). By broth dilution MIC tests RP 59500 was highly active against penicillin-resistant S. pneumoniae and vancomycin-resistant Enterococcus faecium, but showed poor activity against E. faecalis. In time-kill studies the drug was rapidly bactericidal against S. pneumoniae but failed to kill most enterococci, even in the presence of gentamicin or human serum.

Cefepime is a broad-spectrum cephalosporin that is reported to have enhanced activity against ceftazidime-resistant Gram-negative bacilli. In this study the effects of varying inoculum size on in-vitro susceptibility to cefepime and other selected antimicrobial agents were determined by agar dilution MICs and in time-kill studies. Among strains of Pseudomonas aeruginosa (n = 55) and Enterobacter spp (n = 56) that had previously been identified as ceftazidime-resistant, 73% and 96% were susceptible to cefepime (MIC < or = 16 mg/L), respectively, when tested with an inoculum of 10(4) cfu. However, with an inoculum of 10(7) cfu, 98% and 100% of strains were resistant, respectively. Furthermore, the bactericidal activity of cefepime against ceftazidime-resistant isolates was also inoculum-dependent. In time-kill studies, bactericidal action was obtained only at the lowest concentration of organisms (10(4) cfu/mL). beta-Lactamase extracted from an isolate of P. aeruginosa that demonstrated an inoculum effect had a lower affinity for cefepime than for ceftazidime. Overall, cefepime proved to be more resistant to hydrolysis by the beta-lactamase. However, differences in kinetics of the beta-lactamase against cefepime or ceftazidime do not appear to be of consequence in determining susceptibility of P. aeruginosa and Enterobacter spp. at high bacterial densities, since most strains with chromosomally-mediated beta-lactamase are highly resistant.

The authors review the use of ciprofloxacin, a new oral quinolone antibiotic, for the treatment of bone infections. The article discusses the spectrum of activity, pharmacokinetics, and toxicity of the quinolone agents. The authors also provide a detailed discussion of the efficacy of ciprofloxacin for osteomyelitis in animal studies and human trials.

The effectiveness of antibiotic dosing regimens may be strongly influenced by the effects that drug concentrations at the site of infection have on bacterial population dynamics during the interval after a single dose and the cumulative effects after multiple, intermittent doses. These pharmacodynamic effects involve: (1) the rate and extent of bactericidal action and suppression of bacterial growth in tissues, and (2) persistent postantibiotic antibacterial effects. Antimicrobial agents may each exhibit unique pharmacodynamic effects that can vary with the site of infection and species of microorganism.

In critically ill patients, a good outcome of an infection episode often requires early institution of appropriate antimicrobial therapy. The choice of one specific antimicrobial agent or combination of agents over another requires consideration of the nature of the etiologic organism, the host, and the drug(s).

The clinical efficacy of clindamycin was compared with that of penicillin in a randomized study of the treatment of community-acquired putrid lung abscess. After starting therapy, patients treated with clindamycin had a shorter febrile period and fewer days of fetid sputum than patients treated with penicillin (mean 4.4 versus 7.6 days and 4.2 versus 8.0 days, respectively, p less than 0.05). Four of 20 patients treated with penicillin had clinically significant pulmonary or pleural extension of their infection within 10 days after starting therapy; this was not found in any of 19 patients treated with clindamycin (p less than 0.05). Penicillin treatment failed in two additional patients after 20 days of therapy. Within 1 month after treatment, 1 of 4 patients given penicillin for 3 weeks had relapse, but none of the 13 patients given clindamycin for 3 or 6 weeks, and none of the 5 patients given penicillin for 6 weeks had relapse. Overall, only 8 of 15 patients treated with penicillin who could be followed to the end of the study were cured, whereas all 13 patients treated with clindamycin who could be followed were cured (p less than 0.01). These results suggest that penicillin may not be optimal therapy for anaerobic lung abscess.

Moxalactam, a potent new beta-lactam antibiotic with a relatively wide spectrum of activity against facultative and anaerobic gram-negative bacilli, was evaluated in vitro and in 28 patients with a variety of severe infections with moxalactam-susceptible organisms (minimum inhibitory concentration less than or equal to 31 microgram/ml). Although therapy was successful in most of these patients, caution is suggested because of the development of resistance on therapy in one patient, persistence of Bacteroides fragilis endocarditis in another, and for certain organisms, a significant inoculum effect on the minimum inhibitory concentration and minimum bactericidal concentration of moxalactam.

The minimal inhibitory concentration (MIC) of five penicillins (carbenicillin, ticarcillin, mezlocillin, piperacillin and Bay k 4999) againstEscherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Proteus mirabilis, indole positiveProteus sp. andEnterobacter species was determined by an agar dilution method. Bay k 4999 and piperacillin were found to be the most active of the semi-synthetic penicillins tested againstP. aeruginosa andEnterobacteriaceae. Bay k 4999 was slightly more active than piperacillin againstE. coli, about as active as piperacillin againstPseudomonas, K. pneumoniae, P. mirabilis and indole positiveProteus, but more active than piperacillin againstEnterobacter species.

Fragments of normal human adult vagina, when explanted onto glass slides gave rise to outgrowing sheets of pure epithelium, which had microscopic morphological features in common with normal vaginal epithelium. Infrequent fibroblast contamination was observed. Proliferating epithelial cells formed multilayers of stratified squamous epithelium and demonstrated a progressive decrease in proliferative activity after 14 days. Continuous lines of epithelial cells were not obtained. Even in the absence of estrogens, transmission electron microscopy revealed evidence of keratinization of the superficial cells of the multilayer. Scanning electron microscopy of the surface of mature epithelial cells in culture revealed ultrastructural features that closely resembled those present on the surface of exfoliated cells obtained by scraping the vagina in vivo. This in vitro tissue culture model of human vaginal epithelium may provide a simple method of studying factors that influence vaginal epithelium growth, maturation and function.

After a 500-mg dose of cefaclor, the mean peak plasma level was 12.4 μg/ml and after a 250-mg dose it was 5 μg/ml in normal volunteers. Food intake significantly reduced absorption. Probenecid prolonged plasma levels. Mean plasma half-life in normal volunteers was 0.8 h. Only about 50% of the dose was excreted in the urine within 4 h in normal volunteers. Plasma half-life in patients with renal insufficiency was only about 3 h, which suggests that cefaclor may be eliminated by nonrenal mechanisms in humans. Urinary levels of cefaclor were adequate to inhibit susceptible pathogens even in patients with moderately severe renal failure. Plasma half-life during hemodialysis was 2.1 h and rose to 2.8 h after dialysis.

Anagardiffusion methodusing paperdisks onplates seeded withClostridium perfringens andincubated anaerobically toassayserumlevels ofmetronidazole is described. Thelowest serum metronidazole concentration thatcouldbemea- sured was 0.7ug/ml, andtheaverageerrorwas 4%for5,ug/ml. Thisassaycould measure metronidazole inthepresenceofgentamicin or inthepresenceof penicillin, withtheuseofpenicillinase incorporated intotheassayplates, orin presenceofpenicillin, methicillin, andcephalothin withprior exposureofthe specimen tobeta-lactamase. Metronidazole (Flagyl) hasbeenreported to haveexcellent invitro antibacterial activity against awidevariety ofanaerobic bacteria (3) andrecently wasfoundtobeeffective inthe treatment ofinfections causedbyanaerobic bacteria (3). Previously, concentrations ofmet- ronidazole inbodyfluids havebeenassayed chemically (1), butnomicrobiological assay has beenreported. Thepresent report describes a simple, accurate, microbiological assay ofmet- ronidazole inserumorotherbodyfluids by usinga modification ofan agardiffusion method(2).

The activity of sisomicin, gentamicin, and tobramycin against 273 clinical bacterial isolates was about equal (except for greater activity of tobramycin against Pseudomonas) and was greater than that of BB-K 8 as determined by antibiotic dilution methods in agar and broth.

Against more than 90% of 200 bacterial strains tested in vitro, the inhibitory concentration of gentamicin and tobramycin was 3.1 μg/ml and that of BB-K 8, a new semisynthetic aminoglycoside derivative of kanamycin, was 6.3 μg/ml.

Carbenicillin indanyl sodium, ampicillin, or cephalexin was administered orally to 61 patients with urinary tract infections. Assignment of drug was made by a computer-generated, randomized plan in a double-blind fashion. The rates of cure 4 weeks after therapy were 50, 42, and 50% for patients treated with carbenicillin, ampicillin, and cephalexin, respectively. Failure of therapy was correlated with chronicity of infection and sensitivity of the microorganism to the antibiotic used. Thirty-nine percent of the patients developed side effects, but there were no significant differences in side effects among the three antibiotics. This double-blind study demonstrates that carbenicillin indanyl sodium is as effective as ampicillin and cephalexin in treatment of urinary tract infections.

In a double-blind study with each patient as his own control cephapirin and cephalothin were administered to 20 patients in opposite arms for a period of 48 hr each. Neither the incidence of phlebitis nor the degree of phlebitis was significantly different with the two drugs, and there was no difference in the time of onset of pain or phlebitis.