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Biomedical subjects

C W Stratton

Publications and source records attributed to C W Stratton.

At least 91 records · Page 5Linked to original sources
PubMed1983

Invasive aspergillosis in renal transplant recipients: correlation with corticosteroid therapy.

During a 31-month period in 1979-1981, nine patients at a renal transplant center in Tennessee developed invasive infections with Aspergillus species. Despite an extensive search, no common environmental source of contamination was found. A matched case-control study of host risk factors showed that leukopenia, prior administration of antibiotics, and treatment with azathioprine and antilymphocyte serum were not significantly related to the development of aspergillosis. In contrast, the administration of high-dose corticosteroids posed a significant risk. An average daily dose of greater than or equal to 1.25 mg of prednisone/kg per day for the entire interval studied was the best predictor of subsequent invasive infection with Aspergillus.

Adrenal Cortex Hormones↗
PubMed1983

Esophageal candidiasis: treatment with ketoconazole.

Three patients with esophageal candidiasis were treated with a new orally administered antifungal agent, ketoconazole. Favorable results were obtained in two patients; in the remaining patient other foci of candidal infection developed while the patient was receiving ketoconazole.

Administration, Oral↗
PubMed1983

Comparison of the Staph-Ident system with a conventional method for species identification of urine and blood isolates of coagulase-negative staphylococci.

The Staph-Ident system (Analytab Products) for species identification of coagulase-negative staphylococci was compared with the conventional method of Kloos and Schleifer (21). A total of 101 clinical isolates from urine cultures and 95 clinical isolates from blood cultures were studied: overall agreement between the two methods was 86%. We concluded that the Staph-Ident system is a practical test for most clinical microbiology laboratories and that results obtained from this rapid test are comparable to those obtained from the more cumbersome conventional method. Additional investigations are needed to determine the clinical relevance of such species identification.

Blood↗
PubMed1982

Correlation of serum bactericidal activity with antimicrobial agent level and minimal bactericidal concentration.

Few data are available to show how serum dilution test results correlate with results of antimicrobial assays and determinations of minimal inhibitory concentrations (MICs) and minimal bactericidal concentrations (MBCs). Serum dilution tests were performed for 65 patients with bacteremia from serious infections. Assays for antimicrobial agent levels and determinations fo MICs and MBCs against the infecting organisms were performed simultaneously. Mueller-Hinton broth and Mueller-Hinton broth supplemented with Ca++, Mg++, and pooled human serum were compared as diluents for the serum either medium yielded positive correlations, better correlations were found between measured and expected serum bactericidal activities when both ther serum dilution test dilutions and the MIC and MBC determinations were done in the supplemented MHB-human serum solution.

Anti-Bacterial Agents↗
PubMed1982

In vitro comparison of clindamycin and pirlimycin (U-57930E) activity against Staphylococcus aureus.

The activities of clindamycin and its derivative, pirlimycin (U-57930E), were compared against 100 strains of Staphylococcus aureus, using a microtiter broth dilution technique. Minimal inhibitory concentrations demonstrated that pirlimycin was comparable to clindamycin but offered no increase in activity against either methicillin-susceptible or methicillin-resistant S. aureus.

Clindamycin↗
PubMed1982

Candidal suppurative peripheral thrombophlebitis.

Transient candidemia is common with prolonged intravenous therapy. Sustained candidemia, however, usually indicates a persistent focus of infection. A complication of intravenous therapy not previously emphasized is persistent candidemia caused by candidal suppurative peripheral thrombophlebitis. We report six cases that appeared during intravenous therapy: the infection was characterized by a thrombosed peripheral vein at an intravenous site with manifestations for candida septicemia with or without disseminated candidiasis. In two patients, the source of the process was occult; the examination showed only a thrombosed noninflamed vein. In all cases, surgical exploration showed the thrombosed veins to be suppurative with positive cultures for Candida. Special stains, moreover, showed Candida in the luminal clot and the vascular wall. In the five surviving patients, cure was achieved by excision of the affected vein. Four received a short course of amphotericin B and 5-fluorocytosine, and one patient received amphotericin B only.

Adult↗
PubMed1981

Granulomatous tenosynovitis and carpal tunnel syndrome caused by Sporothrix schenckii.

Although the usual form of sporotrichosis is a lymphocutaneous lesion, Sporothrix schenckii can cause articular disease that is difficult to diagnose. We describe two patients with sporotrichosis who presented with tenosynovitis and the carpal tunnel syndrome. A tissue specimen is required for a precise diagnosis; granulomatous tenosynovitis suggests an infectious cause. Unless appropriate cultures for bacteria, mycobacteria and fungi are obtained, the diagnosis may be missed or delayed. Mouse inoculations may be required to isolate S. schenckii from tissue, which rarely shows the delicate fungus in histologic sections. Our patients were cured by a combination of synovectomy and the intravenous administration of amphotericin B. Sporotrichosis should be considered in the differential diagnosis of the carpal tunnel syndrome, particularly when surgical exploration discloses a granulomatous tenosynovitis.

Adult↗
PubMed1981

A rapid paper-disc test for penicillinase.

A practical acidimetric assay for penicillinase production using penicillin and phenol red impregnated in paper discs was developed. Blank discs were first impregnated with buffered penicillin G and, after drying, with 1% phenol red. For use, a disc was added to a bacterial suspension made in saline solution. A yellow color within 1 to 30 min of incubation indicated penicillinase production. These discs were tested against Staphylococcus aureus, Haemophilus influenzae, and Neisseria gonorrhoeae, and the assay was found to be a simple, rapid, and accurate method for detection of penicillinase.

Bacteria↗
PubMed1981

Minimum inhibitory and bactericidal concentrations of 44 antimicrobial agents against three standard control strains in broth with and without human serum.

Standard minimum inhibitory and bactericidal concentrations are not established for most antimicrobial agents against strains of bacteria commonly used for quality control in susceptibility testing. The effects of cation and human serum supplementation of broth on the values are also unknown. Therefore, we performed 10 minimum inhibitory and bactericidal concentration determinations for 44 antimicrobial agents against the standard control strains Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923, and Pseudomonas aeruginosa ATCC 27853 in Mueller-Hinton broth and in Mueller-Hinton broth supplemented with calcium, magnesium, and 50% pooled human serum. Agreement of replicates was within one twofold dilution 97% of the time. Supplemented Mueller-Hinton broth gave higher minimum inhibitory concentrations for 24 antibiotics against S. aureus, for 17 drugs against E. coli, and for 12 drugs against P. aeruginosa, whereas it gave lower minimum inhibitory concentrations for 1 antibiotic against S. aureus, for 5 against E. coli, and for 5 against P. aeruginosa. Results for minimum bactericidal concentrations were similar. Added serum did not further affect the increased resistance of P. Aeruginosa to aminoglycosides encountered with cation supplementation of broth. These results provide expected values for the quality control strains when minimum inhibitory and bactericidal concentrations are determined in these two Mueller-Hinton media.

Anti-Bacterial Agents↗
PubMed1980

Human cytomegalovirus DNA: physical maps for restriction endonucleases BglII, hindIII and XbaI.

It is proposed that the genome of human cytomegalovirus (HCMV) consists of two unique sequences, L and S, bounded by two sets of redundant sequences (P. Sheldrick et al. unpublished data). In this arrangement the terminal sequences (TR1 and TR8) are repeated in an intenal inverted form (IR1 and IR8) and delimit L and S. After restriction endonuclease cleavage of the DNA, four o.5 M and four 0.25 M fragments are found, indicating that HCMV DNA preparations consist of four equimolar populations differing only in the relative orientation of the L and S components. Cleavage of the CMV DNA with the restriction endonucleases BglII, HindIII and XbaI results in 32, 27 and 21 fragments, respectively. The arrangement of these fragments has been determined using molecular hybridization techniques, identification of terminal fragments and the identification of linkage groups by double-digestion. In this report the physical maps for the restriction endonucleases BglII, HindIII and XbaI are presented.

Base Sequence↗
PubMed1980

Hemophilus influenzae pneumonia in adults: report of five cases caused by ampicillin-resistant strains.

Recently there has been increased recognition of Hemophilus influenzae as a cause of pneumonia in adults. Although ampicillin-resistant strains of Hemophilus influenzae have been a major problem in pediatric practice, such strains have not previously been noted to be a significant problem in the treatment of adult pneumonia. We report 5 cases of pneumonia caused by beta-lactamase-producing strains of Hemophilus influenzae. These organisms were susceptible to chloramphenicol but resistant to ampicillin. Cure was achieved by treatment with chloramphenicol after the initial treatment with ampicillin had failed. The ability of a microbiology laboratory to isolate and to test routinely for ampicillin-resistant strains is an important factor in the successful treatment of Hemophilus influenzae infections.

Adult↗
PubMed1978

Spontaneous bacterial peritonitis. A review of 28 cases with emphasis on improved survival and factors influencing prognosis.

During a five year period, 28 episodes of spontaneous bacterial peritonitis were documented. The number of cases recognized annually increased during the study period. Clinical and laboratory features of spontaneous bacterial peritonitis were similar to those previously reported; however, mortality was considerably lower (57 per cent). Factors associated with adverse prognosis were increasing hepatic encephalopathy, more than 85 per cent granulocytes in peripheral blood or ascitic fluid, total bilirubin greater than 8 mg/dl and serum albumin less than 2.5 g/dl. Temperature greater than 38 degrees C was associated with increased survival. Infection by enteric organisms was associated with higher mortality than infection by nonenteric organisms. Unexpectedly, patients with bacteremia fared no worse than those whose blood remained sterile. The data suggest that in patients with leukocyte counts greater than 1,000 cells/mm3 and more than 85 per cent granulocytes in their ascitic fluid, the likelihood of spontaneous bacterial peritonitis is high. Such patients deserve empiric antibiotic therapy pending the results of appropriate cultures.

Adult↗
PubMed1978

Tuberculoid tenosynovitis and carpal tunnel syndrome caused by Mycobacterium szulgai.

Mycobacterium szulgai, a scotochromogenic mycobacterium, is a newly recognized pathogen of man and has been reported to cause pulmonary infections, olecranon bursitis and cervical adenitis. We isolated M. szulfai from granulomatous tissue removed at surgery from a young florist with the carpal tunnel syndrome. The organism was susceptible to ethambutol and rifampin but resistant to isoniazid. Cure was achieved by debridement and chemotherapy with ethambutol and rifampin. Neither the source in our patient nor the natural habitat of M. szulgai is known. Because it resembles M. gordonae and M. flavescens, common scotochromogenic mycobacteria in tapwater, care must be taken to avoid dismissing M. szulgai as a contaminant when it is isolated from tissue.

Adult↗
PubMedDate not supplied

Comparison of the bactericidal activity of cefotaxime and desacetylcefotaxime alone and in combination against Bacteroides fragilis group organisms.

Through the use of time-kill kinetic studies, the bactericidal activity of cefotaxime (CTX) and desacetylcefotaxime (dCTX) alone and in combination against 18 strains of Bacteroides fragilis group was studied. Each isolate was tested at subinhibitory, inhibitory, and suprainhibitory concentrations of each drug as determined from the MIC values. Overall CTX was more bactericidal than dCTX at each of the three concentration levels tested. The combination of CTX and dCTX showed comparable bactericidal activity to CTX at the subinhibitory and inhibitory concentrations, even though each component was present at only one-half the concentration of CTX alone. At suprainhibitory concentrations, the combination of CTX/dCTX appeared synergistic since the combination with each component at a concentration of 1 x MIC was as bactericidal as CTX at a concentration of 4 x MIC. CTX and dCTX alone and in combination exhibited comparable bactericidal activity against test isolates with high (greater than or equal to 32 micrograms/ml) or low (less than or equal to 16 micrograms/ml) MICs. Thus, in vitro the combination of CTX and its naturally occurring metabolite dCTX interacts to produce an additive or synergistic effect against strains of B. fragilis group. Whether the in vitro testing of the combinations is more relevant to clinical outcome than testing CTX alone needs further study.

Bacteroides↗
PubMedDate not supplied

Evaluation of cefotaxime alone and in combination with desacetylcefotaxime against strains of Staphylococcus aureus that produce variants of staphylococcal beta-lactamase.

We evaluated cefotaxime (CTX) alone and in combination with its metabolite, desacetylcefotaxime (dCTX) against strains of Staphylococcus aureus that produce the four recognized variants of staphylococcal beta-lactamase and a beta-lactamase-producing isolate characterized by the expression of borderline resistance to methicillin. Although macrodilution MICs revealed that dCTX was less active than CTX against these strains (geometric means of 16 micrograms/ml and 4 micrograms/ml, respectively), the addition of clinically achievable concentrations of dCTX to CTX resulted in a reduction in the observed CTX MICs. This effect was similar to although less pronounced than that obtained by combining clavulanic acid with cefazolin. The increased antistaphylococcal activity noted by MIC determinations was confirmed with kill-kinetic studies. Determination of the relative rates of hydrolysis of selected cephalosporins showed that neither CTX nor dCTX were appreciably hydrolyzed by the variant staphylococcal enzymes. Evaluation of the effect of CTX and dCTX upon the staphylococcal beta-lactamases demonstrated that neither agent inhibited the destruction of a 100 microM solution of nitrocefin, although the reduction of CTX and cefazolin MICs by low concentrations of dCTX suggests that the dCTX metabolite may act as a competitive inhibitor of beta-lactamase. These observations may explain the previously demonstrated clinical efficacy of CTX used alone for the treatment of serious infections caused by S. aureus.

Cefazolin↗