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Biomedical subjects

C S Bryan

Publications and source records attributed to C S Bryan.

186 records · Page 11Linked to original sources
PubMedDate not supplied

Clinical, epidemiologic and microbiologic features of a persistent outbreak of amikacin-resistant Serratia marcescens.

This article describes a prolonged outbreak (January 1977 to February 1980) of amikacin-resistant Serratia marcescens (ARSM) urinary infections and the methods used for its control. Significant factors predisposing to ARSM urinary tract infection included an extended hospital stay, being in the urology ward, and undergoing urologic surgery. There had been on prior administration of amikacin or of other aminoglycosides in 20 of 27 patients with ARSM urinary tract infections. Chronically infected patients who required multiple hospitalizations represented a major reservoir for the perpetuation of the outbreak, overshadowing the importance of aminoglycoside use. Traditional control measures and even a major change in the inanimate environment were only partially effective in controlling the outbreak, but treatment of bacteriuric patients in the urology unit with "second and third generation" cephalosporins interrupted patient-to-patient transmission. No new cases of ARSM bacteriuria appeared in the urology unit in the ensuing 12 months.

Amikacin↗
PubMedDate not supplied

Analysis of 1,186 episodes of gram-negative bacteremia in non-university hospitals: the effects of antimicrobial therapy.

Over the five-year period 1977-1981, we studied 1,186 episodes of bacteremia due to Enterobacteriaceae and Pseudomonadaceae in the four non-university hospitals of a single metropolitan area. Overall patient mortality was 36.3%, and mortality attributed specifically to infection was 19.0%. The importance of severity of underlying disease, site of infection, microorganism, and age--previously determined to be prognostic factors in studies conducted at tertiary-care centers--was confirmed. Appropriate initial antimicrobial therapy (defined as the administration of an effective agent in adequate dose and by a suitable route of administration on the first calendar day on which blood cultures were positive) did not improve survival compared with the use of an ineffective antimicrobial agent or no therapy at all. However, appropriate antimicrobial therapy subsequent to the first calendar day on which blood cultures were positive clearly affected survival. These findings confirm previous conclusions regarding the frequency and severity of gram-negative bacteremia and the overall impact of antimicrobial therapy on this condition. These studies also suggest the possibility that the definition of optimal initial therapy in some groups of patients should be reconsidered.

Adolescent↗
PubMedDate not supplied

Patterns of bacteremia in pediatrics practice: factors affecting mortality rates.

All episodes of bacteremia occurring in pediatric practice (birth to age 17) in the major hospitals of one metropolitan area between 1977 and 1981 were analyzed to determine current patterns of bacteremia and associated mortality. The overall mortality for 713 episodes of bacteremia was 13.6%. However, mortality attributed specifically to bacteremia, according to the criteria used in this study, was only 7.6%. Thirty-four of the 54 deaths attributed to bacteremia occurred in the neonatal period. Five deaths were attributed to bacteremia during the second and third years of life, and only three deaths were attributed to bacteremia in patients between 3 and 16 years of age. No deaths were attributed to bacteremia arising from the following sources: otitis media, osteomyelitis, septic arthritis, skin infections, endocarditis, urinary tract infection or infection clearly due to vascular access devices.

Adolescent↗
PubMedDate not supplied

Bacteremia in diabetic patients: comparison of incidence and mortality with nondiabetic patients.

We determined the incidence of bacteremia and associated mortality in diabetic and nondiabetic patients in the four major hospitals of one metropolitan area over the 5-yr period 1977-1981. Mortality rates, based on episodes of bacteremia, were similar in diabetic and nondiabetic patients in most instances. Diabetic patients experienced lower mortality rates from Enterobacteriaceae bacteremia compared with nondiabetic patients; this finding was explained by a greater tendency for diabetic patients to have Escherichia coli bacteremia due to community-acquired urinary tract infection. However, the incidence of bacteremia due to all microorganisms was increased twofold in diabetic patients and the incidence of Enterobacteriaceae bacteremia was increased threefold. Because of their increased incidence of bacteremia, diabetic patients in this population were nearly twice as likely to die as a result of bacteremia compared with nondiabetic patients. Thus, the frequent occurrence of bacteremia among patients with diabetes mellitus represents a significant problem.

Adolescent↗