Biomedical subjects
B Holmes
Publications and source records attributed to B Holmes.
Health maintenance organisations.
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Isolation of Flavobacterium thalpophilum from a wound.
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Numerical analysis of electrophoretic protein patterns of Providencia alcalifaciens strains from human faeces and veterinary specimens.
Twenty-five strains of Providencia alcalifaciens from various countries have been characterized by one-dimensional SDS-PAGE of cellular proteins. They comprised 15 from human faeces, one from duck faeces, one from a guinea-pig eye and eight from unknown sources. Also included, for reference purposes, were the type strains of three other Providencia species. The protein patterns, which contained 45-50 discrete bands, were highly reproducible and were used as the basis for two numerical analyses. In the first, in which the principal protein bands (in the 33-40 kD range) were excluded, the 25 Prov. alcalifaciens strains formed, at the 83% S level, a single cluster whilst the three Providencia reference strains remained unclustered. In the second, which included all the protein bands, the 25 Prov. alcalifaciens strains formed 10 clusters at the 85% S level. We conclude that high resolution PAGE combined with computerized analysis of protein patterns provides the basis for typing clinical strains of Prov. alcalifaciens. Reference strains of each of the 10 PAGE types identified are available from NCTC for inclusion in future studies.
Identification of Enterobacteriaceae with the Minitek system.
A total of 417 strains (361 Enterobacteriaceae, 56 Vibrionaceae) was examined in all the available Minitek system tests. The results were processed through four successive identification schemes devised by the manufacturer and the proportion of strains correctly identified, not identified or incorrectly identified determined for each scheme. From the results, a probability matrix was constructed incorporating all 35 Minitek tests. Test results for each strain were then processed through this matrix to determine its success in identification. From the matrix the order of separating value of the tests was determined. Forty-three of the strains were each tested three times to assess the level of test reproducibility; the corrected error rate was 0.85%.
Incidence of vaginal Weeksella virosa (formerly group IIf).
The antimicrobial susceptibilities, biochemical properties, and cultural characteristics of six strains of Weeksella virosa (formerly group IIf) were determined. The main characteristics of this non-fermentative organism were production of cytochrome oxidase, gelatinase, and indole, but a lack of saccharolytic activity. A study was then made of the isolation rates of Weeksella virosa from high vaginal swabs from 300 women: a healthy control group (n = 100), a general group with symptoms of vaginal infection (n = 100), and 100 women from a remand centre, where likelihood of exposure to sexually transmitted disease might be expected to be higher. The incidence of Weeksella virosa was found to be 2% in the first two groups. This suggests that, irrespective of the presence of pathogens, the incidence of the species in the general female population is around 2%. A much higher incidence (15%) was found in the third group, suggesting sexual transmission of the organism.
Treatment of male impotence--a pharmacologic erection program.
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Identification and distribution of Flavobacterium meningosepticum in clinical material.
During the 19 year period ending December 1984, 82 (1.7%) of 4840 strains of Gram-negative non-fermentative bacteria submitted to the National Collection of Type Cultures (NCTC) for computer-assisted identification were Flavobacterium meningosepticum. These figures suggest either that F. meningosepticum occurs only rarely in clinical material in the UK, or that when it does occur it is not always recognized. The sources from which the NCTC strains were isolated are reported and also the characteristics by which the species may be identified. The clinical significance of F. meningosepticum is reviewed, particularly its role in neonatal meningitis, of which there have been but two reported cases in the UK, both imported. The susceptibility of the species to antimicrobial agents is discussed and also antimicrobial therapy of neonatal meningitis due to this species.
Numerical analysis of electrophoretic protein patterns of Providencia rustigianii strains from human diarrhoea and other sources.
Twenty strains of Providencia rustigianii (including the type strain of Prov. friedericiana) have been characterized by one-dimensional SDS-PAGE of cellular proteins. They comprised 12 strains (almost exclusively associated with the intestinal tract) from humans, plus eight largely from the intestinal tract of pig, penguin and environmental sources. The protein patterns, which contained 45-50 discrete bands, were highly reproducible and were used as the basis for two numerical analyses. In the first, which included all the protein bands, the 20 Prov. rustigianii strains formed six clusters at the 88% S level. One of these clusters included the type strains of both Prov. friedericiana and Prov. rustigianii, thereby confirming the synonymy of these two species. In the second analysis, the principal protein bands were excluded. At the 86% S level the 20 Prov. rustigianii strains formed a single cluster, whilst a field strain of Morganella morganii and the respective type strains of three other Providencia species remained unclustered. The total protein pattern of the type strain of Prov. alcalifaciens was very similar to that of Prov. rustigianii phenon 3 and the M. morganii field strain, which indicates that careful biochemical characterization may be necessary to ascribe strains to a species before typing by the PAGE technique. Alternatively, a selective analysis of the protein bands may be used to confirm the identity of the strains, as shown in this study.
Evaluation of Mast-ID 15 system for identifying Enterobacteriaceae, some Vibrionaceae, and Acinetobacter.
Six hundred and twenty one strains (555 Enterobacteriaceae, 46 Vibrionaceae, and 20 Acinetobacter) were examined in the Mast system. The results were consulted in the code book supplied by the manufacturer and those not listed were processed through the manufacturer's full database held on an Apricot microcomputer in our laboratory. The proportion of strains correctly identified was 88%, with 9% not identified, and 3% incorrectly identified.
A revised probability matrix for the identification of gram-negative, aerobic, rod-shaped, fermentative bacteria.
The results of the identification of 933 strains of Gram-negative, aerobic, rod-shaped, fermentative bacteria (Enterobacteriaceae, Pasteurellaceae, Vibrionaceae) by a probabilistic method, in a computer, are given. The identification rate on the matrix was 89.2%. Many of the strains were atypical and had caused difficulty in identification in medical diagnostic laboratories. The results are given for each taxon by genus and species.
A probability matrix for the identification of gram-negative, aerobic, non-fermentative bacteria that grow on nutrient agar.
Results of the identification of 621 strains of Gram-negative, aerobic, non-fermentative bacteria by a computer-based probabilistic method are given. Although many of the strains were atypical and have caused difficulty in identification in the medical diagnostic laboratory, the identification rate on this matrix was 91.5%.
The identification of Pseudomonas cepacia and its occurrence in clinical material.
During the 19 year period ending December 1984, 4840 strains of Gram-negative non-fermentative bacteria were submitted to the National Collection of Type Cultures for identification. Of these, 195 strains (4.0% of the total) were identified as Pseudomonas cepacia which demonstrates both that the species is regularly encountered in clinical material in the UK and that several laboratories have experienced difficulty in identifying the organism. The sources from which the 195 strains were isolated are reported and also the characteristics by which the species may be recognized. The clinical significance of Ps. cepacia is reviewed, and the resistance of this species to disinfectants and antimicrobial agents commonly used to treat pseudomonas infections is discussed to underline the necessity for the precise identification of Ps. cepacia.
Identification and distribution of Pseudomonas stutzeri in clinical material.
During the 19 year period ending December 1984, 114 (2.4%) of 4840 strains of Gram-negative non-fermentative bacteria submitted, mainly by laboratories in the UK, to the National Collection of Type Cultures for computer-assisted identification were strains of Pseudomonas stutzeri. These figures suggest that Ps. stutzeri is a relatively uncommon species in clinical material in the UK but that when it does occur laboratories have difficulty in identifying it. The sources from which the strains were isolated and also characteristics of the species by which it may be recognized are reported. The clinical significance of Ps. stutzeri is discussed and also the susceptibility of this species to antimicrobial agents.
Cefsulodin treatment for serious Pseudomonas aeruginosa infections.
Cefsulodin, a narrow-spectrum cephalosporin with excellent antipseudomonal activity was used to treat 48 patients with 51 Pseudomonas aeruginosa infections. These included osteomyelitis, infected prostheses, post-operative and post-traumatic superficial wounds, decubitus and stasis ulcers, lower respiratory tract infections and infections of the urinary tract. Many of the patients were compromised by underlying debilitating conditions such as severe trauma, diabetes mellitus, vascular impairment, and abuse of alcohol and drugs. In cases of polymicrobial infections, a concomitant non-antipseudomonal antibiotic was sometimes administered. Cefsulodin was administered intravenously to 47 patients and by intramuscular injections to one individual. The dosage ranged from 0.5 to 2.0 g every six hr and duration of therapy was from 4 to 70 days. A satisfactory clinical response was observed in 88% of the patients. P. aeruginosa was eradicated from 76% of the infection sites. Failures, which included relapse within one year, were generally associated with prior severe trauma or vascular impairment in cases of osteomyelitis. Reinfections and superinfections developed in 12 individuals. Adverse reactions reported for two patients were nausea and vomiting. A third patient had transient increases in alkaline phosphatase and SGOT. These data indicate that cefsulodin is an effective and safe antibiotic in various types of P. aeruginosa infections.
Indoramin. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in hypertension and related vascular, cardiovascular and airway diseases.
Indoramin is a postsynaptic selective alpha 1-adrenoceptor antagonist used in the treatment of hypertension. In contrast to some other alpha-blockers, animal studies suggest that its blood pressure lowering effect results from relaxation of peripheral arterioles as a consequence of blockade of postsynaptic alpha 1-adrenoceptors. Furthermore, unlike some other alpha-blockers, this lowering of blood pressure is rarely associated with reflex tachycardia or postural hypotension. Therapeutic trials have shown indoramin to be effective in lowering blood pressure in all grades of hypertension: mild and moderate hypertension when used alone, but generally in combination with a thiazide diuretic, and in moderate to moderately severe hypertension when used in combination with a beta-blocker and diuretic. In a few small comparative studies, no significant difference was found in the blood pressure lowering effects between indoramin and methyldopa, propranolol and prazosin. Side effects were similar for indoramin, propranolol and methyldopa; however in the 1 comparative study with prazosin, prazosin produced a lower incidence of sedation. Indeed, the most common side effect with indoramin therapy has been sedation of a mild to moderate and/or transient nature, reported in about 19% of cases. Other side effects which have sometimes led to a withdrawal of indoramin treatment have been dry mouth, dizziness, and in males, failure of ejaculation; however, side effects may be reduced by starting therapy with smaller doses and titrating more gradually.
The Cumberlege Report--another view.
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Aztreonam in the treatment of serious orthopedic infections.
Aztreozam was evaluated in the treatment of a variety of orthopedic infections. Included were 17 patients with osteomyelitis, three with purulent arthropathy with prostheses, and 16 with superficial infections secondary to trauma or surgical procedure. Pathogens were gram-negative bacilli sensitive to aztreonam. Concomitant antibiotics were administered for gram-positive cocci that were present initially or by superinfection. Infecting organisms included Pseudomonas aeruginosa (minimal inhibitory concentration 4 to 16 micrograms/ml), Serratia marcescens, Enterobacter cloacae, Enterobacter sakazakii, Morganella morganii, Citrobacter freundii, Proteus vulgaris, Proteus rettgeri, Acinetobacter calcoaceticus and others (all with minimal inhibitory concentrations less than 1.0 microgram/ml). Dosage of aztreonam was 2 to 8 g per day administered intravenously or intramuscularly for five to 52 days. Clinical and bacteriologic responses were adequate in all instances. Recurrences were observed in two individuals with osteomyelitis and one with purulent arthropathy. Adverse clinical or laboratory observations were infrequent and inconsequential.