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Biomedical subjects

C A Kauffman

Publications and source records attributed to C A Kauffman.

At least 145 records · Page 8Linked to original sources
PubMed1987

High-level aminoglycoside-resistant enterococci. Colonization of nursing home and acute care hospital patients.

Enterococci with high-level resistance (HLR) to gentamicin sulfate and other aminoglycosides have emerged as pathogens in recent years. More than half of all current isolates of enterococci at the Ann Arbor (Mich) Veterans Administration (VA) Medical Center are HLR strains. We determined the rate of colonization with HLR enterococci in patients in the acute care hospital, the attached nursing home, and a private nursing home. We also studied the factors related to colonization and the molecular relatedness of strains of HLR enterococci in these settings. In the VA facilities, 47.4% of patients in the nursing home and 36.1% of patients in the acute care hospital were colonized, compared with a 4.3% colonization rate in the private nursing home. Intravenous or Foley catheters and bedridden status were associated with colonization in the acute care setting; the need for advanced nursing care and prior antibiotic therapy were associated with colonization in the nursing home. Environmental surfaces were contaminated with HLR enterococci in both VA settings. Plasmid analysis of HLR strains revealed identity between both patient and environmental strains in the nursing home care unit and the acute care hospital. Nursing home patients, with their high rate of colonization with HLR enterococci and their frequent movement into the acute care hospital, may play a role as a reservoir for subsequent transmission of HLR enterococci.

Cross Infection↗
PubMed1987

Infective endocarditis: clinical features in young and elderly patients.

The elderly constitute an increasing percentage of patients with infective endocarditis. The disease manifestations and outcomes in 53 episodes of endocarditis in patients over the age of 60 were reviewed and compared with 55 episodes of endocarditis in patients less than 40 years of age and 46 episodes of endocarditis in patients aged 40 to 60. The percentage of cases caused by staphylococci and streptococci were roughly equal in all groups. Enterococci, Streptococcus bovis, and coagulase-negative staphylococci were more common in the elderly. In the elderly, invasive vascular procedures were the most common source of infection. Endocarditis acquired nosocomially accounted for 23 percent of all episodes in older patients. The elderly reported fewer symptoms and showed a diminished febrile response. Errors in diagnosis were noted in 68 percent of elderly patients, and a delay in initiating appropriate therapy was more common in this age group. The mortality rate was significantly higher in the elderly (45.3 percent) than in the middle-aged (32.6 percent) and young (9.1 percent). Endocarditis in elderly patients is often nosocomially acquired, is difficult to diagnose, and is associated with a higher mortality than noted in younger patients.

Adult↗
PubMed1987

Emergence of nosocomial methicillin-resistant Staphylococcus aureus and therapy of colonized personnel during a hospital-wide outbreak.

At the Ann Arbor Veterans Administration Medical Center, 30 patients over a 6-month period became nosocomially infected or colonized by methicillin-resistant Staphylococcus aureus. Immediate institution of strict infection control measures, in conjunction with surveillance cultures of personnel and treatment of carriers, did not limit spread of the outbreak strain of MRSA. Multiple nonoutbreak strains, phenotypically exhibiting heteroresistance, were also uncovered. Thirteen hospital personnel were identified as MRSA carriers. Trimethoprim-sulfamethoxazole (TMP-SMX) and rifampin initially eradicated the carrier state, documented by anterior nares cultures in 13 courses of treatment in 11 employees. However, three employees were recolonized, one at one month, one at both one and four months, and one at four months. Treatment of the carrier state reservoir among personnel appeared to have no effect on the emergence and spread of nosocomial MRSA.

Carrier State↗
PubMed1987

Recurrent pseudobacteremias traced to a radiometric blood culture device.

Five clusters of pseudobacteremias over a seven-month period were traced to a BACTEC radiometric device. Four episodes were due to enterococcus and one involved Staphylococcus aureus. Each cluster began with multiple positive blood cultures from a patient with clinical evidence of bacteremia. On subsequent days each bottle in sequence yielded growth of the identical organism, as shown by phage typing and antibiograms. Cultures from patients believed to be infected with the organisms tested positive earlier (mean = 1.4 days) than those patients believed to be pseudobacteremic (mean = 4.8 days). Investigation pointed toward the BACTEC device as the most likely source. Resin beads were found in the needle on several occasions and were shown to be transferred from bottle to bottle. We postulated that contaminated resin beads or liquid from a positive bottle remained in the needle above the portion that was heat-sterilized, contaminating the next bottle when it was sampled.

Bacteriological Techniques↗
PubMed1987

Single-concentration broth microdilution test for detection of high-level aminoglycoside resistance in enterococci.

Growth in a single broth microdilution well containing gentamicin at a concentration of 500 micrograms/ml predicted high-level resistance to gentamicin (MIC, greater than or equal to 2,000 micrograms/ml) in 505 of 508 clinical isolates of enterococci. Failure to achieve synergistic killing with the combination of penicillin and an aminoglycoside was demonstrated with 100% specificity in 20 strains which showed resistance to 500 micrograms of gentamicin per ml. We recommend this procedure be adopted as a routine screening test to detect high-level aminoglycoside resistance in enterococci.

Anti-Bacterial Agents↗
PubMed1987

Age and protein malnutrition: effects on the febrile response.

Elderly hospitalized patients frequently do not mount a vigorous febrile response. This diminished response could be due to the combined effects of age and protein malnutrition, a common problem in the elderly. We studied the effect of mild protein deprivation on the febrile response to interleukin-1 (IL-1) and endotoxin in young, middle-aged, and elderly Fischer rats. In each age group, rats received either a standard (23% casein) or low protein (8% casein) diet for 5 weeks (young rats) or 8 weeks (middle-aged and elderly rats). Each rat received an intraperitoneal injection of IL-1, 10 micrograms/kg endotoxin, or 100 micrograms/kg endotoxin and temperatures were measured over 6 h by implanted biotelemetry devices. Protein deprivation decreased the febrile response to IL-1 in all age groups and to endotoxin only in the young and middle-aged rats. Increasing age along did not decrease the febrile response to either pyrogen. Increasing age and protein deprivation did not have an additive effect in decreasing the febrile response to IL-1 or endotoxin.

Age Factors↗
PubMed1987

Nosocomial infection by gentamicin-resistant Streptococcus faecalis. An epidemiologic study.

Enterococci with high-level resistance to gentamicin account for 55% of clinical isolates of enterococci found in patients at the Ann Arbor Veterans Administration Medical Center. We prospectively studied cultures obtained from all 100 patients hospitalized from 1 December 1985 through 23 January 1986 on the surgical and thoracic intensive care units and a general medical floor. Ten patients' cultures grew colonies of gentamicin-resistant enterococci--six after admission to the intensive care units and four after hospitalization on the medical ward. The initial sites of colonization were the rectal and perineal areas in seven patients, sternal wound in one, urine in one, and the rectal and perineal areas as well as urine after Foley catheter insertion in one. Nine patients died and three of the deaths were associated with enterococcal infection. The acquisition of resistant strains was associated with previous and more frequent exposure to antimicrobial agents, and with geographic clustering of patients. Resistant enterococci were isolated from the hands of hospital personnel and were frequently isolated from environmental surfaces. Nosocomial acquisition and interhospital spread of gentamicin-resistant enterococci was shown to have occurred when plasmid content was used as an epidemiologic marker.

Adult↗
PubMed1986

Endogenous pyrogen/interleukin-1 production in aged rats.

The effect of aging on the ability of macrophages to produce endogenous pyrogen/interleukin-1 (EP/IL-1) was tested in 13 young adult (2-3 mo) and 13 aged (24-26 mo) Fischer rats using a febrile response assay. Peritoneal macrophages from aged rats produced EP/IL-1 as well as young adult rats. Decreased production of EP/Il-1 does not appear to explain the diminished febrile response seen in the elderly.

Aging↗
PubMed1986

Candidiasis. A diagnostic and therapeutic challenge.

Candida infections are becoming more common for a number of reasons. Diagnosis of local infections is relatively simple, and therapy with topical antifungal drugs or ketoconazole (Nizoral) is usually adequate. However, diagnosis of disseminated candidiasis is more difficult, frequently requiring biopsy confirmation. Amphotericin B (Fungizone Intravenous), often in combination with flucytosine (Ancobon), may be appropriate. In catheter-induced fungemia, antifungal therapy may be necessary to avoid deep-seated infection with Candida.

Antifungal Agents↗
PubMed1986

Fever and malnutrition: endogenous pyrogen/interleukin-1 in malnourished patients.

The effect of protein-calorie malnutrition on the release of endogenous pyrogen/interleukin-1 (EP/IL-1), the protein responsible for the induction of fever, was investigated in 18 hospitalized patients with chronic malnutrition. Monocytes from the 18 patients and from 19 healthy controls were cultured overnight after stimulation with Staphylococcus epidermidis. The presence of EP/IL-1 was tested by injecting culture supernatants into rabbits and measuring the maximum febrile response (delta Tmax). Malnourished patients produced significantly less EP/IL-1 than controls (delta Tmax = 0.27 +/- 0.04 degrees C for patients vs 0.49 +/- 0.03 degrees C for controls, p less than 0.001). The poor febrile response in the malnourished patients was related to low serum albumin and retinol-binding protein, but not to thyroxine-binding albumin or lymphocyte number. This abnormality may help explain the poor febrile response often noted in hospitalized debilitated patients.

Adult↗
PubMed1985

Group A streptococcal bacteremia in intravenous drug abusers.

The clinical and microbiologic features of group A streptococcal bacteremia are described in 40 patients, all of whom were seen between January 1982 and June 1983 and all of whom were intravenous drug abusers. Eleven patients had endocarditis (two with left-sided and nine with right-sided), and 29 patients had bacteremia without endocardial involvement. Twenty-seven of the 29 patients without endocarditis had soft tissue infections, primarily groin abscesses. Constitutional symptoms were more severe in patients with endocarditis. The two patients with left-sided endocarditis died despite antimicrobial therapy; all nine patients with right-sided endocarditis and all 29 patients without endocarditis were cured of their infection. A predominant strain of group A streptococcus was identified by serologic typing, suggesting a common source for these cases.

Adult↗
PubMed1985

Fever in uremia: production of leukocytic pyrogen by chronic dialysis patients.

Uremic patients frequently have low baseline temperatures and a blunted febrile response to infection. We investigated the first step in the generation of a febrile response, the production of leukocytic pyrogen (LP) by blood monocytes, in 12 patients on chronic hemodialysis, five patients on continuous ambulatory peritoneal dialysis (CAPD), and 17 control subjects. No significant differences were found in the amount of LP produced by hemodialysis patients, CAPD patients, and control subjects. Uremic serum did not decrease LP production by monocytes from control subjects. Hemodialysis patients who were consistently hypothermic (mean oral predialysis temperature less than or equal to 35.6 degrees F) produced as much LP as those with more normal oral temperatures (mean oral predialysis temperature greater than or equal to 36.8 degrees F). Decreased production of LP does not explain the blunted febrile response noted in patients with chronic renal failure.

Adult↗
PubMed1985

Oral antibiotic therapy for osteomyelitis of the foot in diabetic patients.

Although osteomyelitis of the foot in diabetic patients is generally considered a difficult infection to cure, the literature contains few reports comparing various treatment regimens. We have described two diabetic patients with osteomyelitis of the foot treated with oral antibiotics chosen on the basis of their broad activity against the pathogens commonly found in such infections. Both patients responded well to therapy and have shown no evidence of active osteomyelitis for 11 and four months, respectively.

Aged↗
PubMed1985

Septic arthritis in the elderly.

The clinical and microbiologic features of septic arthritis in 23 elderly patients are reviewed. Fifteen patients had pre-existing joint diseases, predominantly osteoarthritis and rheumatoid arthritis. Eight patients had underlying systemic illnesses, and eight patients were receiving systemic corticosteroid therapy prior to the development of septic arthritis. The knee was the joint most commonly infected. Although Staphylococcus aureus was the major pathogen (52.2 per cent of patients), enteric gram-negative bacilli were found in seven of 23 patients (30.4 per cent). Five patients died (21.7 per cent mortality), two as a result of their infection and three of nosocomial Pseudomonas sepsis. Eight of the 18 survivors (44.4 per cent) developed osteomyelitis in the contiguous bone. Return of joint function was slow in all patients. Septic arthritis in the elderly is difficult to treat and has a poor outcome, possibly because pre-existing joint disease is very common and enteric gram-negative bacilli are often the causative organisms.

Aged↗
PubMed1985

Effect of age on fever and acute-phase response of rats to endotoxin and Salmonella typhimurium.

Age-related effects on endogenous pyrogen-mediated febrile and acute-phase responses to endotoxin and Salmonella typhimurium challenge were investigated in young adult and aged Fisher 344 rats. After injection of endotoxin, the febrile response over 6 h and the fall in plasma iron and zinc after 6 h were determined in 14 young adult and 14 aged rats in their thermoneutral zone (26 degrees C) and in 14 young adult and 14 aged rats maintained in a cold environment (15 degrees C). Although at 26 degrees C aged rats showed only a slightly diminished febrile response compared with that of young adult rats, at 15 degrees C they had a markedly diminished febrile response compared with that of young adult rats. At both 26 and 15 degrees C, the injection of endotoxin led to a fall in iron and zinc concentrations in the plasma of both young adult and aged rats. The intact trace metal response diminished but febrile response suggest that aged rats are able to produce endogenous pyrogen but have a reduced capacity to respond to this substance. In 22 aged and 22 young adult rats maintained at 26 degrees C and challenged with S. typhimurium, the febrile response was significantly less in the aged rats but the survival rate was virtually identical. When 10 young adult and 10 aged rats were placed at a temperature of 15 degrees C after injection with S. typhimurium, the febrile response in the aged rats was significantly lower than that in the young adult rats at only one time point, and the survival rate did not differ between the two age groups. Survival after challenge with S. typhimurium was not influenced adversely by the diminished febrile response.

Acute Disease↗
PubMed1985

Effect of age on the febrile response of rats to endogenous pyrogen.

Mechanisms underlying the decreased febrile response in the elderly have not been elucidated. One hypothesis is that elderly persons have a decreased response at the hypothalamic or peripheral effector level to endogenous pyrogen (EP). We studied the response to human monocyte-derived EP in young adult and aged Fischer 344 rats, a strain known to have an age-dependent decrease in the febrile response to endotoxin. EP was given intraperitoneally to aged and young adult rats kept at 26 degrees C (thermoneutral zone) or at 15 degrees C (a mild cold stress), in order to accentuate possible peripheral thermoeffector defects. At 26 degrees C, the febrile response in aged rats was similar to that in young adult rats. At 15 degrees C, the febrile response was lower in both groups, but the aged rats did not differ from the young adult rats. When EP was given by intracerebroventricular injection to aged and young adult rats, at 26 or at 15 degrees C, no differences in the febrile responses were noted. Thus, it appears that in aged Fischer rats the hypothalamic response and the peripheral effector response to EP are intact. Further studies on the production and release of EP by rat monocytes are needed to explain the diminished febrile response to endotoxin in the aged rat.

Aging↗
PubMed1984

Endocarditis as a complication of indwelling right atrial catheters in leukemic patients.

Three patients with acute leukemia who had chronic indwelling right atrial catheters developed endocarditis. In all cases, the infection was cured with antibiotics only after removal of the infected catheter. Although infective endocarditis has been rarely noted in leukemic patients, the use of chronic indwelling catheters may lead to an increased incidence of this infection in these patients.

Aged↗