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Biomedical subjects

C S Bryan

Publications and source records attributed to C S Bryan.

At least 127 records · Page 7Linked to original sources
PubMed1986

Promptness of antibiotic therapy in acute bacterial meningitis.

We reviewed 135 cases of acute community-acquired bacterial meningitis at a municipal teaching hospital during a six-year period, with special emphasis on promptness of initial antimicrobial therapy. Overall mortality was 5% for the 121 childhood cases, compared to 43% for the 14 adult cases (P less than .001). The mean duration between arrival in the emergency department and the administration of appropriate antibiotics was 2.1 hours for the pediatric cases, compared to 4.9 hours for the adult cases (P less than .02). Factors that may contribute to delays in institution of appropriate antimicrobial therapy for adult patients with meningitis include the relative infrequency of this condition, the presence of concomitant disease processes, and the frequent practice of obtaining a computed tomography scan prior to performing lumbar puncture. Prompt institution of antimicrobial therapy for acute meningitis, especially for adult pneumococcal meningitis, remains a major challenge for emergency physicians.

Acute Disease↗
PubMed1986

Endemic bacteremia in Columbia, South Carolina.

Between 1977 and 1981, there were 4.9 episodes of community-acquired bacteremia and 5.1 episodes of hospital-acquired bacteremia per 1,000 patients in the four major hospitals of one metropolitan area. Case fatality rates were 30.1 per cent based on deaths due to all causes and 14.7 per cent based on deaths attributed specifically to bacteremia. Patients who experienced bacteremia had a 12-fold excess in mortality compared with other patients. Bacteremia occurred more frequently and was associated with greater case fatality rates at university-affiliated teaching hospitals compared with nonteaching community hospitals. At the nonteaching community hospitals, the odds of mortality for patients with bacteremia were lower even after adjustment for age, sex, severity of underlying medical problems, and severity of infection. Patients on private services at a teaching municipal hospital experienced greater odds of mortality compared with private patients at two nonteaching community hospitals. These latter observations may reflect, at least in part, limitations in the standard parameters used for determining severity of underlying medical problems and severity of infection.

Adolescent↗
PubMed1985

Gentamicin vs cefotaxime for therapy of neonatal sepsis. Relationship to drug resistance.

An outbreak of serious infections due to gentamicin-resistant Klebsiella pneumoniae occurred in a neonatal intensive care unit in which the combination of gentamicin sulfate and ampicillin sodium had been used for standard initial therapy for suspected sepsis for nearly 11 years. After institution of control measures that included the substitution of cefotaxime sodium for gentamicin in the standard regimen, the outbreak promptly subsided. Nevertheless, a second outbreak of serious infections due to cefotaxime-resistant Enterobacter cloacae began ten weeks later. Sequential stool cultures from patients in the unit confirmed the disappearance of gentamicin-resistant K pneumoniae and the emergence of cefotaxime-resistant E cloacae after the change in antibiotic policy. These observations suggest that routine use of newer cephalosporins for therapy of suspected sepsis may lead to the emergence of drug-resistant microorganisms more rapidly than has occurred with the aminoglycosides.

Ampicillin↗
PubMed1985

Mortality associated with enterococcal bacteremia.

Our data support the concept that enterococcal bacteremia provides a marker for life-threatening disease processes but, apart from endocarditis, seldom explains the immediate cause of death. Although over-all mortality among 189 patients who experienced 190 episodes of enterococcal bacteremia was 39 per cent, only 14 deaths were attributed directly to the episode of bacteremia on the basis of definitions used in this study. Upon closer scrutiny, the role of enterococcal infection even in these 14 deaths was not entirely clear except for one fatal instance of endocarditis. We could not correlate outcome with use of specific antimicrobial therapy directed against enterococci.

Adolescent↗
PubMed1984

Bacteroides bacteremia. Analysis of 142 episodes from one metropolitan area.

Overall mortality for 142 patients with Bacteroides bacteremia encountered in the four hospitals of one metropolitan area between 1977 and 1982 was 41%. Only 43% of deaths of these patients, however, were attributed directly to Bacteroides infection according to the criteria used in this study. Deaths of patients with Bacteroides bacteremia, compared with deaths of patients with bacteremia due to aerobic gram-negative rods, were less likely to occur early after onset of bacteremia. Choice of antimicrobial therapy had no obvious relationship to eventual outcome. Nonobstetrical Bacteroides bacteremia identifies a group of patients at high risk of death during hospitalization. The diversity of both clinical and microbiologic features of these infections, however, makes specific recommendations regarding optimum therapy difficult to formulate.

Adolescent↗
PubMed1984

Community-acquired bacteremic urinary tract infection: epidemiology and outcome.

We studied 313 episodes of community-acquired bacteremic urinary tract infection in 4 hospitals of 1 metropolitan area from 1977 to 1981. Although over-all mortality rate for these patients was 13.7 percent, only 15 deaths were attributed directly to bacteremic urinary tract infection according to the criteria used in this study. Of these 15 deaths 13 occurred among patients on medical services, all but 1 of whom had alcoholic liver disease, malignancy and/or chronic neurologic disease. The other patient had brittle diabetes mellitus with renal papillary necrosis and chronic renal failure. In this population 10.4 episodes of community-acquired bacteremic urinary tract infection occurred per 10,000 patients. However, these infections appeared to explain the deaths only of patients with severe underlying diseases.

Adolescent↗
PubMed1984

Hospital-acquired bacteremic urinary tract infection: epidemiology and outcome.

Analysis of 221 episodes of hospital-acquired bacteremic urinary tract infection in 4 hospitals of 1 metropolitan area from 1977 to 1981 revealed an over-all mortality rate of 30.8 per cent. The mortality rate attributed specifically to bacteremic urinary tract infection was 12.7 per cent. Of the 28 patients whose deaths were attributed directly to hospital-acquired bacteremic urinary tract infection 19 were on medical services and all had focal or diffuse central nervous system disease, malignancy, alcoholic liver disease or cirrhosis, advanced arteriosclerosis with renal failure and/or diabetes mellitus with obliterative peripheral vascular disease. Extrapolation of these data suggests that 3,520 deaths in the United States each year are directly caused by hospital-acquired bacteremic urinary tract infection but that these deaths may be limited virtually to high risk patients with poor prognoses from underlying diseases.

Adolescent↗
PubMed1984

Staphylococcal bacteremia: current patterns in nonuniversity hospitals.

We studied 390 consecutive episodes of Staphylococcus aureus bacteremia in the four nonuniversity hospitals of one metropolitan area between 1977 and 1981. Overall mortality was 31%, with 52% of deaths being attributed to the infection. The 4.9% incidence of recognized endocarditis was lower than that previously reported. Although 41% of deaths occurred by the end of the third day after positive blood cultures had been obtained, choice of antimicrobial therapy bore no apparent relationship to eventual clinical outcome.

Adolescent↗
PubMed1984

Ceftriaxone levels in blood and tissue during cardiopulmonary bypass surgery.

One gram of ceftriaxone was given intravenously to 15 patients approximately 2 h before cardiopulmonary bypass surgery. Ceftriaxone levels in plasma (mean +/- standard deviation) were 60.4 +/- 18.8 micrograms/ml (range, 17.0 to 96.0 micrograms/ml) at the beginning of bypass, 44.2 +/- 16.6 micrograms/ml (range, 9.4 to 78.6 micrograms/ml) at the end of bypass, and 19.6 +/- 9.6 micrograms/ml (range, 4.2 to 47.1 micrograms/ml) the following morning, 18.1 to 24.7 h after infusion of ceftriaxone. Concentrations in the sternal bone were 4.7 +/- 2.1 micrograms/g (range, 1.0 to 10.1 micrograms/g; tissue-to-plasma ratios, 0.066 +/- 0.036). Concentrations in the atrial appendage were 7.7 +/- 1.8 microgram/g (range, 3.6 to 10.2 micrograms/g; tissue-to-plasma ratios, 0.143 +/- 0.062). These data suggest that a single dose of ceftriaxone might be useful for prevention of infection due to susceptible pathogens.

Aged↗
PubMed1984

Bacteremic nosocomial pneumonia. Analysis of 172 episodes from a single metropolitan area.

We studied 172 episodes of bacteremia attributed to nosocomial pneumonia in 168 patients, observed in the 4 major hospitals of a single metropolitan area over a 5-yr period. Overall mortality for these patients was 58%. Deaths attributed directly to nosocomial pneumonia occurred almost exclusively in patients with serious and largely irreversible underlying diseases. These data confirm the high mortality associated with endemic hospital-acquired pneumonia. Although some deaths appear to be preventable, primarily by measures designed to reduce the risk of aspiration, analysis of the data herein raises doubts whether overall mortality can be significantly reduced by currently available measures.

Adolescent↗