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Biomedical subjects

D Kaye

Publications and source records attributed to D Kaye.

At least 91 records · Page 5Linked to original sources
PubMed1989

In vitro postantibiotic effect of daptomycin (LY146032) against Enterococcus faecalis and methicillin-susceptible and methicillin-resistant Staphylococcus aureus strains.

The suppression of bacterial growth that persists after brief exposure to antimicrobial agents has been termed the postantibiotic effect (PAE). This pharmacodynamic interaction varies for each microorganism-antimicrobial agent combination. Daptomycin (LY146032) is a new lipopeptide antibiotic with activity against gram-positive organisms. We studied the in vitro bactericidal activities and PAEs of the following drugs: daptomycin compared with penicillin G and vancomycin, without and with gentamicin against Enterococcus faecalis strains; daptomycin compared with nafcillin and vancomycin against methicillin-susceptible Staphylococcus aureus strains; and daptomycin compared with vancomycin against methicillin-resistant S. aureus strains. Daptomycin, alone and when used in combination with gentamicin, exhibited greater bactericidal activity and in general produced a longer PAE than standard effective regimens against the organism strains studied.

Anti-Bacterial Agents↗
PubMed1989

Principles of selection and use of antibacterial agents.

The selection of an antimicrobial treatment regimen is based on many factors, including the nature of the infection, the identity and susceptibility pattern of the infecting organism, and the pharmacokinetics and pharmacodynamics of the drug(s). Principles of susceptibility testing, pharmacology, and monitoring of therapy are discussed in this article.

Anti-Bacterial Agents↗
PubMed1988

Comparison of difloxacin, enoxacin, and cefazolin for the treatment of experimental Staphylococcus aureus endocarditis.

This study compared difloxacin administered orally, enoxacin administered orally, and cefazolin administered intramuscularly for the treatment of experimental Staphylococcus aureus endocarditis. Difloxacin significantly reduced bacterial counts of vegetations compared with enoxacin. This study demonstrated that difloxacin was significantly more effective than enoxacin and as effective as cefazolin for the treatment of S. aureus endocarditis in rabbits.

Administration, Oral↗
PubMed1988

Daptomycin (LY146032) treatment of experimental enterococcal endocarditis.

This study compared daptomycin (LY146032) with penicillin G procaine and vancomycin without and with gentamicin for treatment of experimental enterococcal endocarditis. The strain of Streptococcus (Enterococcus) faecalis used in this study was killed by daptomycin in vitro in broth but not in serum. In rabbits treated for 3 days, daptomycin significantly reduced bacterial counts of vegetations compared with no therapy but was significantly less effective than penicillin G procaine or vancomycin. Daptomycin-gentamicin significantly reduced bacterial counts of vegetations compared with daptomycin alone but was significantly less effective than vancomycin plus gentamicin. The efficacy of daptomycin-gentamicin did not differ significantly from that of penicillin G procaine-gentamicin. The lack of enterococcal killing by daptomycin alone in serum and in experimental endocarditis is probably related to the high protein binding of the agent.

Animals↗
PubMed1988

Nosocomial pneumonia.

Nosocomial pneumonia remains a challenging problem in critically ill patients in terms of both diagnosis and therapy. The clinical picture is often confusing; confounding factors such as congestive heart failure, ARDS, and interstitial lung disease may obscure the presence of pneumonia. Previous antimicrobial therapy or the presence of large numbers of colonizing organisms contribute to the difficulty of diagnosis. The use of sheathed fiberoptic bronchoscopy with quantitative culture and biopsy is probably the best initial invasive test when routine diagnostic methods fail; open lung biopsy remains the ultimate standard for diagnosis. Empiric therapy is often necessary and should be designed to treat organisms suspected of being the etiologic pathogens either on the basis of preliminary laboratory results (gram and acid-fast stains) or the clinical setting.

Cross Infection↗
PubMed1988

Asymptomatic bacteriuria in the elderly.

Bacteriuria in the elderly is common and usually asymptomatic. In the absence of symptoms or obstructive uropathy (which is rare in women), bacteriuria in the elderly appears to be a benign disease, and therefore antimicrobial therapy is probably not warranted.

Aged↗
PubMed1987

Clinical efficacy of ciprofloxacin therapy for gram-negative bacillary osteomyelitis.

The efficacy and toxicity of ciprofloxacin, an orally administered fluoroquinolone, were evaluated in 24 infections in 23 patients with osteomyelitis caused by aerobic gram-negative bacilli. The diagnosis was confirmed by surgical findings and the results of bone biopsy and culture of bone or deep soft tissue. The aerobic gram-negative bacilli were Pseudomonas aeruginosa (15 isolates), Serratia marcescens (five isolates), Escherichia coli (three isolates), Enterobacter species (three isolates), Proteus mirabilis (one isolate), Pseudomonas fluorescens (one isolate), and Klebsiella pneumoniae (one isolate). Minimal bactericidal concentrations (MBCs) were 1.56 micrograms/ml or less for all but one isolate. Nine infections were polymicrobial, involving aerobic gram-positive cocci or anaerobes in addition to aerobic gram-negative bacilli. Additional antibiotics to which the aerobic gram-negative bacilli were resistant were given when the additional organisms were resistant to ciprofloxacin. Patients received 750 mg of ciprofloxacin twice daily for a mean of 62 days. Peak serum levels of ciprofloxacin were at least threefold higher than the MBCs in 20 of 24 patients. Twenty of 22 infections in which a full course of therapy was completed were without evidence of active disease at one to 17 months posttreatment. A sternotomy wound infection relapsed after eight weeks of therapy with a newly resistant S. marcescens strain, and an infection of a compound fracture relapsed two months posttreatment with a still sensitive P. aeruginosa strain. Toxicity was minimal in most patients: eosinophilia (six patients), nausea (eight patients), mild elevation in transaminase levels (three patients), pruritus (one patient), diarrhea (two patients), thrush (two patients), rash (two patients), and mild leukopenia (one patient). Two additional patients had severe side effects (vertigo in one and acute renal failure in another) that required discontinuation of ciprofloxacin therapy. Overall, ciprofloxacin is a promising agent for the oral treatment of gram-negative bacillary osteomyelitis.

Administration, Oral↗
PubMed1987

Therapy vs no therapy for bacteriuria in elderly ambulatory nonhospitalized women.

This prospective randomized study was undertaken to determine the efficacy of antimicrobial therapy compared with no therapy for bacteriuria in elderly ambulatory nonhospitalized women. Sixty-one women (mean age, 85.8 years) with bacteriuria were in the no therapy control group and 63 women (mean age, 85.8 years) with bacteriuria were in the therapy group; none had symptoms of urinary tract infection. One short course of antimicrobial therapy achieved a cure rate of 68.3% (43 of 63 women cured) two weeks after treatment. During the six-month follow-up period, ten (16.4%) of 61 women in the no therapy group and five (7.9%) of 63 women in the therapy group developed symptomatic urinary tract infection. At the time of six-month follow-up, 19 (34.5%) of 55 women in the no therapy group and 35 (63.6%) of 55 women in the therapy group did not have bacteriuria. We conclude that for asymptomatic bacteriuria in elderly ambulatory nonhospitalized women, short-course antimicrobial therapy is effective at two-week follow-up and that antimicrobial therapy can eliminate bacteriuria in most of these women for at least a six-month period.

Aged↗
PubMed1987

The role of bacterial adherence in urinary tract infections in elderly adults.

In an attempt to clarify host factors responsible for the acquisition of bacteriuria in elderly adults, bacterial adherence to uroepithelial cells obtained from 83 elderly participants and 40 young controls was studied. Seven uropathogenic strains of E. coli expressing different adhesions were used. Bacteria adhered significantly better to cells of young women than young men (p less than .0001) and elderly women than elderly men (p less than .03). The greatest adherence was in young women and the least in young men. In women without bacteriuria, aging was not associated with increased susceptibility to bacterial attachment. Moreover, there was no increase in the adherence of E. coil strains to uroepithelial cells of bacteriuric elderly women in comparison to abacteriuric elderly women. In men, however, aging was associated with increased bacterial adherence (p less than .02). Susceptibility to bacterial adherence does not appear to be responsible for the increased frequency of E. coli bacteriuria in elderly women but may be a permissive factor in elderly men.

Adult↗
PubMed1987

Comparison of difloxacin, enoxacin, and cefoperazone for treatment of experimental Enterobacter aerogenes endocarditis.

This study compared difloxacin administered orally, enoxacin administered orally, and cefoperazone administered intramuscularly for the treatment of experimental Enterobacter aerogenes endocarditis. Difloxacin significantly reduced bacterial counts of vegetations, as compared with enoxacin and cefoperazone. Enoxacin and cefoperazone did not differ significantly. This study demonstrated that difloxacin was significantly more effective than enoxacin and cefoperazone for the treatment of E. aerogenes endocarditis in rabbits.

Animals↗
PubMed1987

Asymptomatic bacteriuria in the elderly.

Bacteriuria in the elderly is common and usually asymptomatic. In the absence of symptoms and/or obstructive uropathy (which is rare in women), bacteriuria in the elderly appears to be a benign disease and therefore antimicrobial therapy is probably not warranted.

Aged↗
PubMed1987

Decline in mitogen induced proliferation of lymphocytes with increasing age.

We previously reported that mitogen-induced proliferative responses of lymphocytes in the elderly were significantly lower than in young individuals. To determine when this decline occurs, we evaluated the responses of 26-30 subjects of each decile from the third to the tenth decile to the T cell mitogens, phytohaemagglutinin (PHA) and concanavalin A (ConA), and the T dependent B cell mitogen, pokeweed mitogen (PWM). There was a significant decrease in the responses of the 70-, 80- and 90-year-olds to PHA and ConA (less than 40% of the 20-year-olds; P less than 0.01). The 80- and 90-year-olds also showed a decreased response to PWM (approximately 50%; P less than 0.01). The 60-year-olds showed a decreased response to all three mitogens but only the PHA and ConA responses were significantly decreased (P less than 0.01). The 50-year-olds showed a decreased response to ConA, while the 40-year-olds showed decreased responses to both PHA and ConA; both significant at P less than 0.01. The decreased response of the 40-year-olds, however, was only seen in the females. This may be due to the hormonal changes associated with menopause. The general trend of the data suggests that there is a gradual decrease in mitogen-induced proliferative responses with increasing age, large differences become apparent at the age of 60, with a further decrease in the 70s, and most importantly, they remain fairly constant thereafter. Of interest is that only three of the 111 subjects less than 60 years old failed to mount a proliferative response and in each case this was to only one mitogen, while 42 of 118 subjects greater than 60 years old did not respond to at least one mitogen. Ten of these older subjects (2/28 of the 60-year-olds) did not respond to any of the three mitogens (P less than 0.01). This lack of response may be important since we have found a significant association between the lack of response to all three mitogens and increased mortality.

Adult↗
PubMed1986

Epidemiology of bacteriuria in an elderly ambulatory population.

This study of bacteriuria in elderly (mean age 85 years, range 68 to 103) Jewish subjects of mostly middle and upper class attempted to determine disease prevalence, define the turnover in infected subjects, and assess the relation between functional status and infection. The prevalence of bacteriuria (midstream clean-catch method) was assessed in 373 women and 150 men. It was higher in women (18.2 percent) than in men (6.0 percent) (p less than 0.001) and was more common in functionally impaired nursing home residents (23.5 percent) than in apartment house dwellers (12.1 percent) (p less than 0.01). In longitudinal studies, 260 subjects (184 women and 76 men) had three urine culture surveys at six-month intervals. The cumulative percent infected on at least one survey was high (women 30.4 percent, men 10.5 percent). However, persistence of the same organism on all three surveys was surprisingly infrequent (women 6.0 percent, men 1.3 percent), and the turnover of infected and noninfected subjects was considerable. Persistence of bacteriuria on all three surveys was significantly more common in nursing home residents (13.9 percent) than in apartment house dwellers (3.1 percent) (p less than 0.01). Thus, bacteriuria is common in the elderly and appears related to functional status. However, the turnover of infected and noninfected subjects was high, and surprisingly, persistence was not found in most. The transient nature of bacteriuria in most provides support against the treatment of asymptomatic bacteriuria in the elderly.

Activities of Daily Living↗