human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The purpose of this statement is to up date the recommendations by the American Heart Association ( AHA ) for the prevention of infective endocarditis that were last published in 1997 . METHODS AND RESULTS A writing group was appointed by the AHA for their expertise in prevention and treatment of infective endocarditis , with liaison members representing the American Dental Association , the Infectious Diseases Society of America , and the American Academy of Pediatrics . The writing group review ed input from national and international experts on infective endocarditis . The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and infective endocarditis , in vitro susceptibility data of the most common microorganisms that cause infective endocarditis , results of prophylactic studies in animal models of experimental endocarditis , and retrospective and prospect i ve studies of prevention of infective endocarditis . MEDLINE data base search es from 1950 to 2006 were done for English- language papers using the following search terms : endocarditis , infective endocarditis , prophylaxis , prevention , antibiotic , antimicrobial , pathogens , organisms , dental , gastrointestinal , genitourinary , streptococcus , enterococcus , staphylococcus , respiratory , dental surgery , pathogenesis , vaccine , immunization , and bacteremia . The reference lists of the identified papers were also search ed . We also search ed the AHA online library . The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used . The paper was subsequently review ed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee . CONCLUSIONS The major changes in the up date d recommendations include the following : ( 1 ) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100 % effective . ( 2 ) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis . ( 3 ) For patients with these underlying cardiac conditions , prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa . ( 4 ) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis . ( 5 ) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure . These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations Two consecutive open studies were performed of the efficacy of a prophylactic cefuroxime/metronidazole combination  in abdominal hysterectomy . The first group received a 24-h regimen , the second group a  single pre-operative dose . The incidence of post-operative wound infections and urinary tract infections were similar in both groups [ wound infections in 1/75 versus 2/84 patients ( NS ) , urinary tract infections 4/75 versus 3/84 patients ( NS ) , respectively , in the 24-h group and single-dose group ] . No significant differences in other parameters , such as pyrexia and duration of post-operative hospitalization , could be detected OBJECTIVE The purpose of this study was to determine if antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals ( study drug ) after pelvic organ prolapse and /or urinary incontinence surgery with suprapubic catheterization ( SPC ) decreases urinary tract infection ( uti ) compared with placebo in a r and omized , double-blind , multicenter trial . STUDY DESIGN Six centers participated in this study . After a negative preoperative urine culture , history , surgical and postoperative course , urine culture and symptoms at SPC removal , and at 6 to 8 weeks postoperative , any other UTI and adherence were recorded . To demonstrate a 50 % decrease in the bacteruria rate from 20 % , with 80 % power and alpha of 0.05 , 438 patients were required . Data were evaluated with Student t test and Fisher exact test . RESULTS Of 449 patients enrolled , 211 r and omized to study drug , and 224 r and omized to placebo . No pre- or perioperative differences existed between groups ( all P>.05 ) . Antibiotic prophylaxis decreased positive urine cultures compared with placebo ( 46 % vs 61 % , P=.002 ) , symptomatic UTI at SPC removal ( 7.2 % vs 19.8 % , P=.001 ) , and any other symptomatic UTI 6 to 8 weeks postoperatively ( 18.9 % vs 32.6 % , P=.002 ) . Antibiotic prophylaxis did not decrease symptomatic UTI at the 6- to 8-week postoperative visit ( 1.8 % vs 5.4 % , P=.10 ) . CONCLUSION Antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals decreases UTI compared with placebo after pelvic organ prolapse and /or urinary incontinence surgery with suprapubic catheterization BACKGROUND A history ( or lack thereof ) of penicillin allergy is known to be unreliable in predicting reactions on subsequent administration of the drug . This study tests the usefulness of four penicillin allergen skin tests in the prediction of IgE-mediated reactions subsequent to administration of penicillin . METHODS Eight centers cooperated in the National Institute of Allergy and Infectious Diseases trial of the predictive value of skin testing with major and minor penicillin derivatives .  Hospitalized adults were tested with a major determinant ( octa-benzylpenicilloyl-ocytalysine ) and a minor determinant mixture and its components ( potassium benzylpenicillin , benzylpenicilloate , and benzylpenicilloyl-N-propylamine ) . Patients then received a therapeutic course of penicillin and were observed , for 48 hours , for adverse reactions compatible with an IgE-mediated immediate or accelerated allergy . RESULTS Among 726 history-positive patients , 566 with negative skin tests received penicillin and only seven ( 1.2 % ) had possibly IgE-mediated reactions . Among 600 history-negative patients , 568 with negative skin tests received penicillin and none had a reaction . Only nine of the 167 positive skin test reactors received a penicillin agent and then usually by cautious incremental dosing . Two ( 22 % ) of these nine patients had reactions compatible with IgE-mediated immediate or accelerated penicillin allergy ; both were positive to the two determinants . CONCLUSIONS These data corroborate previous data about the negative predictive value of negative skin tests to these material s. The reaction rate in skin test-positive patients was significantly higher than in those with negative skin tests , demonstrating the positive predictive value of positive tests to both major and minor determinants . The number of patients positive only to the major determinant or only to the minor determinant mix was too small to draw conclusions about the positive predictive value of either reagent alone A r and omized double-blind prospect i ve study on the efficacy of single-dose antibiotic prophylaxis compared cefuroxime versus metronidazole versus the combination of both agents in vaginal hysterectomy . Overall antibiotic prophylaxis was effective in abscess prevention ( one abscess in 68 patients ) . In the metronidazole group a significantly higher grade of morbidity was observed : febrile morbidity 41 % versus 4 % in the two other groups ; bacteriuria 73 % versus 17 % in the cefuroxime group , versus 13 % in the combined group ; urinary tract infection 23 % , versus 0 % in the two other groups ; post-operative prescription of antibiotics 41 % , versus 0 % in the two other groups . Febrile morbidity and bacteriuria correlated positively withEscherichia coli and Proteus spp . These micro-organisms were recovered significantly more often from the vagina of patients in the metronidazole group . Cefuroxime was successful , metronidazole failed in the prevention of minor morbidity . We could not observe any effect from the addition of metronidazole to the cefuroxime prophylaxis OBJECTIVE : Bacterial vaginosis ( BV ) is a known risk factor for postoperative infection following abdominal hysterectomy . Vaginal bacterial flora scored as intermediate has been shown to have the same risk of postoperative infection as BV . METHODS : Women undergoing total abdominal hysterectomy for benign diseases were open-r and omized according to Zelen to either treatment with metronidazole rectally for at least 4 days or no treatment . At the preoperative gynecological examination a vaginal smear was collected and Gram stained . Women with BV or intermediate flora were merged to one group called abnormal vaginal flora . RESULTS : In total 213 women were r and omized to treatment or no treatment . After exclusion of 71 women , 142 women were eligible for analysis . Among the 59 women diagnosed with abnormal vaginal flora there were no vaginal cuff infections in the treated arm , compared with 27 % in the ' no treatment ' arm ( p < 0.01 ) . Treatment also reduced the vaginal cuff infection rate from 9.5 to 2 % among the 83 women with lactobacilli flora . However , this difference was not statistically significant . Treatment had no effect on the rate of wound infections . Intention-to-treat analysis showed a significant reduction in vaginal cuff infections among women r and omized to treatment . CONCLUSION : Pre- and postoperative treatment for at least 4 days with metronidazole rectally reduces significantly vaginal cuff infection among women with abnormal vaginal flora Objective : The purpose of this study was to investigate the efficacy of 200 mg of prophylactic doxycycline in preventing pelvic infection after curettage for spontaneous ( incomplete ) abortion . Methods : A r and omized , prospect i ve , double-blinded study was carried out involving 300 women with an incomplete abortion who were given either placebo or 200 mg of doxycycline orally 30–60 min prior to curettage .  A hematocrit , WBC count , pregnancy test , syphilis serology , Neisseria gonorrhoeae culture , and Micro Trak ( monoclonal antibody test , Syba , San Jose , CA ) for Chlamydia trachomatis were performed . The patients were scheduled for follow-up 2 weeks later . Antibiotic administration for any reason as well as the postoperative infection rate in these women was assessed . Results : Eleven women were excluded from analysis , leaving 289 evaluable . N. gonorrhoeae was isolated from 6 ( 2 % ) women and C. trachomatis from 8 ( 3 % ) women , and the syphilis serology was serofast in 4 ( 1 % ) women . Endometritis complicated the procedure in 4 women who received placebo and in 1 woman who received doxycycline ( P = 0.22 ) . Conclusion : Prophylactic doxycycline is not effective in preventing pelvic infection after curettage for spontaneous ( incomplete ) abortion Background . Bacterial vaginosis ( BV ) and intermediate flora is known risk‐factor for postoperative infection after surgical termination of pregnancy . Vaginal application of 2 % clindamycin cream is an efficacious treatment for BV , but it is not known whether preoperative administration of clindamycin cream might reduce the signs of post‐abortion infection after surgical termination of pregnancy HYPOTHESIS  Surgical site infections ( SSIs ) are a major contributor to patient injury , mortality , and health care costs . Despite evidence of effectiveness of antimicrobials to prevent SSIs , previous studies have demonstrated inappropriate timing , selection , and excess duration of administration of antimicrobial prophylaxis . We herein describe the use of antimicrobial prophylaxis for Medicare patients undergoing major surgery . DESIGN National retrospective cohort study with medical record review . SETTING Two thous and nine hundred sixty-five acute-care US hospitals . PATIENTS A systematic r and om sample of 34,133 Medicare in patients undergoing coronary artery bypass grafting ; other open-chest cardiac surgery ( excluding transplantation ) ; vascular surgery , including aneurysm repair , thromboendarterectomy , and vein bypass operations ; general abdominal colorectal surgery ; hip and knee total joint arthroplasty ( excluding revision surgery ) ; and abdominal and vaginal hysterectomy from January 1 through November 30 , 2001 . MAIN OUTCOME MEASURES The proportion of patients who had parenteral antimicrobial prophylaxis  initiated within 1 hour before the surgical incision ; the proportion of patients who were given a prophylactic antimicrobial agent  that was consistent with currently published guidelines ; and the proportion of patients whose antimicrobial prophylaxis was discontinued within 24 hours after surgery . RESULTS An antimicrobial dose was administered to 55.7 % ( 95 % confidence interval [ CI ] , 54 
    Output:
    
agent
Benefits , harms , and costs Guideline implementation should result in a reduction of cost and related harm of administering antibiotics when not required and a reduction of infection and related morbidities when antibiotics have demonstrated a proven benefit .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The purpose of this statement is to up date the recommendations by the American Heart Association ( AHA ) for the prevention of infective endocarditis that were last published in 1997 . METHODS AND RESULTS A writing group was appointed by the AHA for their expertise in prevention and treatment of infective endocarditis , with liaison members representing the American Dental Association , the Infectious Diseases Society of America , and the American Academy of Pediatrics . The writing group review ed input from national and international experts on infective endocarditis . The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and infective endocarditis , in vitro susceptibility data of the most common microorganisms that cause infective endocarditis , results of prophylactic studies in animal models of experimental endocarditis , and retrospective and prospect i ve studies of prevention of infective endocarditis . MEDLINE data base search es from 1950 to 2006 were done for English- language papers using the following search terms : endocarditis , infective endocarditis , prophylaxis , prevention , antibiotic , antimicrobial , pathogens , organisms , dental , gastrointestinal , genitourinary , streptococcus , enterococcus , staphylococcus , respiratory , dental surgery , pathogenesis , vaccine , immunization , and bacteremia . The reference lists of the identified papers were also search ed . We also search ed the AHA online library . The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used . The paper was subsequently review ed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee . CONCLUSIONS The major changes in the up date d recommendations include the following : ( 1 ) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100 % effective . ( 2 ) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis . ( 3 ) For patients with these underlying cardiac conditions , prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa . ( 4 ) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis . ( 5 ) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure . These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations Two consecutive open studies were performed of the efficacy of a prophylactic cefuroxime/metronidazole combination  in abdominal hysterectomy . The first group received a 24-h regimen , the second group a  single pre-operative dose . The incidence of post-operative wound infections and urinary tract infections were similar in both groups [ wound infections in 1/75 versus 2/84 patients ( NS ) , urinary tract infections 4/75 versus 3/84 patients ( NS ) , respectively , in the 24-h group and single-dose group ] . No significant differences in other parameters , such as pyrexia and duration of post-operative hospitalization , could be detected OBJECTIVE The purpose of this study was to determine if antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals ( study drug ) after pelvic organ prolapse and /or urinary incontinence surgery with suprapubic catheterization ( SPC ) decreases urinary tract infection ( uti ) compared with placebo in a r and omized , double-blind , multicenter trial . STUDY DESIGN Six centers participated in this study . After a negative preoperative urine culture , history , surgical and postoperative course , urine culture and symptoms at SPC removal , and at 6 to 8 weeks postoperative , any other UTI and adherence were recorded . To demonstrate a 50 % decrease in the bacteruria rate from 20 % , with 80 % power and alpha of 0.05 , 438 patients were required . Data were evaluated with Student t test and Fisher exact test . RESULTS Of 449 patients enrolled , 211 r and omized to study drug , and 224 r and omized to placebo . No pre- or perioperative differences existed between groups ( all P>.05 ) . Antibiotic prophylaxis decreased positive urine cultures compared with placebo ( 46 % vs 61 % , P=.002 ) , symptomatic UTI at SPC removal ( 7.2 % vs 19.8 % , P=.001 ) , and any other symptomatic UTI 6 to 8 weeks postoperatively ( 18.9 % vs 32.6 % , P=.002 ) . Antibiotic prophylaxis did not decrease symptomatic UTI at the 6- to 8-week postoperative visit ( 1.8 % vs 5.4 % , P=.10 ) . CONCLUSION Antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals decreases UTI compared with placebo after pelvic organ prolapse and /or urinary incontinence surgery with suprapubic catheterization BACKGROUND A history ( or lack thereof ) of penicillin allergy is known to be unreliable in predicting reactions on subsequent administration of the drug . This study tests the usefulness of four penicillin allergen skin tests in the prediction of IgE-mediated reactions subsequent to administration of penicillin . METHODS Eight centers cooperated in the National Institute of Allergy and Infectious Diseases trial of the predictive value of skin testing with major and minor penicillin derivatives .  Hospitalized adults were tested with a major determinant ( octa-benzylpenicilloyl-ocytalysine ) and a minor determinant mixture and its components ( potassium benzylpenicillin , benzylpenicilloate , and benzylpenicilloyl-N-propylamine ) . Patients then received a therapeutic course of penicillin and were observed , for 48 hours , for adverse reactions compatible with an IgE-mediated immediate or accelerated allergy . RESULTS Among 726 history-positive patients , 566 with negative skin tests received penicillin and only seven ( 1.2 % ) had possibly IgE-mediated reactions . Among 600 history-negative patients , 568 with negative skin tests received penicillin and none had a reaction . Only nine of the 167 positive skin test reactors received a penicillin agent and then usually by cautious incremental dosing . Two ( 22 % ) of these nine patients had reactions compatible with IgE-mediated immediate or accelerated penicillin allergy ; both were positive to the two determinants . CONCLUSIONS These data corroborate previous data about the negative predictive value of negative skin tests to these material s. The reaction rate in skin test-positive patients was significantly higher than in those with negative skin tests , demonstrating the positive predictive value of positive tests to both major and minor determinants . The number of patients positive only to the major determinant or only to the minor determinant mix was too small to draw conclusions about the positive predictive value of either reagent alone A r and omized double-blind prospect i ve study on the efficacy of single-dose antibiotic prophylaxis compared cefuroxime versus metronidazole versus the combination of both agents in vaginal hysterectomy . Overall antibiotic prophylaxis was effective in abscess prevention ( one abscess in 68 patients ) . In the metronidazole group a significantly higher grade of morbidity was observed : febrile morbidity 41 % versus 4 % in the two other groups ; bacteriuria 73 % versus 17 % in the cefuroxime group , versus 13 % in the combined group ; urinary tract infection 23 % , versus 0 % in the two other groups ; post-operative prescription of antibiotics 41 % , versus 0 % in the two other groups . Febrile morbidity and bacteriuria correlated positively withEscherichia coli and Proteus spp . These micro-organisms were recovered significantly more often from the vagina of patients in the metronidazole group . Cefuroxime was successful , metronidazole failed in the prevention of minor morbidity . We could not observe any effect from the addition of metronidazole to the cefuroxime prophylaxis OBJECTIVE : Bacterial vaginosis ( BV ) is a known risk factor for postoperative infection following abdominal hysterectomy . Vaginal bacterial flora scored as intermediate has been shown to have the same risk of postoperative infection as BV . METHODS : Women undergoing total abdominal hysterectomy for benign diseases were open-r and omized according to Zelen to either treatment with metronidazole rectally for at least 4 days or no treatment . At the preoperative gynecological examination a vaginal smear was collected and Gram stained . Women with BV or intermediate flora were merged to one group called abnormal vaginal flora . RESULTS : In total 213 women were r and omized to treatment or no treatment . After exclusion of 71 women , 142 women were eligible for analysis . Among the 59 women diagnosed with abnormal vaginal flora there were no vaginal cuff infections in the treated arm , compared with 27 % in the ' no treatment ' arm ( p < 0.01 ) . Treatment also reduced the vaginal cuff infection rate from 9.5 to 2 % among the 83 women with lactobacilli flora . However , this difference was not statistically significant . Treatment had no effect on the rate of wound infections . Intention-to-treat analysis showed a significant reduction in vaginal cuff infections among women r and omized to treatment . CONCLUSION : Pre- and postoperative treatment for at least 4 days with metronidazole rectally reduces significantly vaginal cuff infection among women with abnormal vaginal flora Objective : The purpose of this study was to investigate the efficacy of 200 mg of prophylactic doxycycline in preventing pelvic infection after curettage for spontaneous ( incomplete ) abortion . Methods : A r and omized , prospect i ve , double-blinded study was carried out involving 300 women with an incomplete abortion who were given either placebo or 200 mg of doxycycline orally 30–60 min prior to curettage .  A hematocrit , WBC count , pregnancy test , syphilis serology , Neisseria gonorrhoeae culture , and Micro Trak ( monoclonal antibody test , Syba , San Jose , CA ) for Chlamydia trachomatis were performed . The patients were scheduled for follow-up 2 weeks later . Antibiotic administration for any reason as well as the postoperative infection rate in these women was assessed . Results : Eleven women were excluded from analysis , leaving 289 evaluable . N. gonorrhoeae was isolated from 6 ( 2 % ) women and C. trachomatis from 8 ( 3 % ) women , and the syphilis serology was serofast in 4 ( 1 % ) women . Endometritis complicated the procedure in 4 women who received placebo and in 1 woman who received doxycycline ( P = 0.22 ) . Conclusion : Prophylactic doxycycline is not effective in preventing pelvic infection after curettage for spontaneous ( incomplete ) abortion Background . Bacterial vaginosis ( BV ) and intermediate flora is known risk‐factor for postoperative infection after surgical termination of pregnancy . Vaginal application of 2 % clindamycin cream is an efficacious treatment for BV , but it is not known whether preoperative administration of clindamycin cream might reduce the signs of post‐abortion infection after surgical termination of pregnancy HYPOTHESIS  Surgical site infections ( SSIs ) are a major contributor to patient injury , mortality , and health care costs . Despite evidence of effectiveness of antimicrobials to prevent SSIs , previous studies have demonstrated inappropriate timing , selection , and excess duration of administration of antimicrobial prophylaxis . We herein describe the use of antimicrobial prophylaxis for Medicare patients undergoing major surgery . DESIGN National retrospective cohort study with medical record review . SETTING Two thous and nine hundred sixty-five acute-care US hospitals . PATIENTS A systematic r and om sample of 34,133 Medicare in patients undergoing coronary artery bypass grafting ; other open-chest cardiac surgery ( excluding transplantation ) ; vascular surgery , including aneurysm repair , thromboendarterectomy , and vein bypass operations ; general abdominal colorectal surgery ; hip and knee total joint arthroplasty ( excluding revision surgery ) ; and abdominal and vaginal hysterectomy from January 1 through November 30 , 2001 . MAIN OUTCOME MEASURES The proportion of patients who had parenteral antimicrobial prophylaxis  initiated within 1 hour before the surgical incision ; the proportion of patients who were given a prophylactic antimicrobial agent  that was consistent with currently published guidelines ; and the proportion of patients whose antimicrobial prophylaxis was discontinued within 24 hours after surgery . RESULTS An antimicrobial dose was administered to 55.7 % ( 95 % confidence interval [ CI ] , 54 
    Output:
    