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Biomedical subjects

D Landman

Publications and source records attributed to D Landman.

At least 19 recordsLinked to original sources
PubMed1998

Deja vu: nosocomial hepatitis B virus transmission and fingerstick monitoring.

PURPOSE: Three patients with acute hepatitis B virus infection were identified who had been hospitalized on the same medical ward during a 19-day period several months earlier. An investigation was undertaken to determine if nosocomial transmission had occurred. SUBJECTS AND METHODS: A cohort study of patients admitted to the medical ward during the 19-day period in 1995 was conducted. In addition, we reviewed medical charts and laboratory records of all patients with acute hepatitis B virus infection who had been admitted to the hospital from 1992 through October 1996 to identify other cases with possible nosocomial acquisition. RESULTS: The 3 patients who had developed acute hepatitis B infection 2 to 5 months after hospitalization on the same medical ward had diabetes mellitus but no identified risk factors for hepatitis B infection. A source patient with diabetes mellitus and hepatitis B "e" antigenemia also was present on the same medical ward at the same time; all 4 patients were infected with the same viral subtype (adw2). Diabetes mellitus and fingerstick monitoring were associated with illness (P <0.001). Through the review of medical charts and laboratory records, 11 additional cases of suspected nosocomial acquisition via fingersticks were identified in 1996, including two clusters involving an unusual subtype of hepatitis B virus (adw4). The fingerstick device employed had a reusable base onto which disposable lancet caps were inserted. There was ample opportunity for cross-contamination among patients because deficiencies in infection control practices, particularly failure to change gloves between patients, were reported by nurses and patients with diabetes mellitus. CONCLUSION: Transmission during fingerstick procedures was the most likely cause of these cases of nosocomial hepatitis B infection. Contamination probably occurred when healthcare workers failed to change gloves between patients undergoing fingerstick monitoring, although other means of contamination cannot be ruled out.

Aged↗
PubMed1997

Activity of disinfectants against vancomycin-resistant Enterococcus faecium.

Vancomycin-resistant enterococci (VRE) often contaminate the hospital environment. We examined the activity of commonly used disinfectants against eight strains of VRE, using a quantitative suspension test method. Isopropyl alcohol and sodium hypochlorite were highly effective. Hydrogen peroxide was ineffective for all strains. After 10 minutes of incubation (the manufactures' recommended time of exposure), three phenolic and three quaternary ammonium compounds also were highly effective. After 3 minutes of exposure, however, occasional failures did occur. With the exception of 3% hydrogen peroxide, most disinfectants appear to be active against VRE.

Anti-Bacterial Agents↗
PubMed1997

Management of infections due to resistant enterococci: a review of therapeutic options.

The incidence of nosocomial enterococcal infection has increased steadily over the past two decades. The treatment of patients with enterococcal infection has been complicated by the emergence of strains possessing high level resistance to aminoglycosides, penicillins and, most recently, glycopeptides. Several recent studies have evaluated alternative antimicrobial agents for use against strains resistant to some or all standard agents. In this report, we review the therapeutic options for the management of antibiotic-resistant enterococcal infection.

Aminoglycosides↗
PubMed1996

Experience with a hospital-wide outbreak of vancomycin-resistant enterococci.

BACKGROUND: Vancomycin-resistant enterococci (VRE) were first detected in our institution in 1991. An outbreak was recognized in late 1992 when there was a sudden rise in the number of patients per month with VRE. Little information exists concerning the natural history of infection with these pathogens, and the effect of antimicrobial therapy is unclear. Recent guidelines emphasize prudent use of vancomycin and prompt institution of barrier precautions to limit the spread of vancomycin resistance. METHODS: Data were obtained by review of microbiologic and clinical records. Patients were categorized according to site of infection, and outcome of therapy was assessed. Hospital antibiotic usage was analyzed to determine any correlation with the outbreak. Infection control measures instituted in 1993 included patient isolation, environmental cleaning, and a reemphasis of barrier precautions. Surveillance cultures were performed to assess the extent of the outbreak in January 1995. RESULTS: VRE were detected in clinical cultures from 159 patients from 1991 through 1994. Mortality rate was 48%, but in most cases death could not be attributed to enterococcal infection. Patients with wound infections healed without specific therapy. Many patients with bacteremia had resolution with ampicillin or without specific therapy. Patients were widely scattered throughout the hospital from the beginning of the outbreak. Hospital usage of cefotaxime correlated with the number of cases. Infection control measures were not successful. Surveillance culture results in January 1995 revealed that 53% of all medical and surgical inpatients had fecal colonization with VRE. Genetic analysis of selected isolates revealed that one strain predominated, but at least seven distinct strains were identified. CONCLUSIONS: Our data suggest that many infections with VRE resolve without specific therapy. The infection control measures we used were ineffective, possibly because of the multiple strains present in our hospital. Isolation of all patients with VRE is impractical when there is widespread fecal carriage.

Adult↗
PubMed1996

Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci.

Infection control practices are not uniformly successful in limiting outbreaks of vancomycin-resistant enterococci (VRE). Despite the implementation of barrier precautions for VRE-infected patients, nearly one-half of the inpatients at our center were found to have gastrointestinal colonization by VRE. In an attempt to control the outbreak, we altered the antibiotic formulary by restricting the use of cefotaxime and vancomycin and adding beta-lactamase inhibitors to replace third-generation cephalosporins. The use of clindamycin was also restricted because of a concomitant outbreak of Clostridium difficile colitis. After 6 months, the average monthly use of cefotaxime, ceftazidime, vancomycin, and clindamycin had decreased by 84%, 55%, 34%, and 80%, respectively (P < .02). The point prevalence of fecal colonization with VRE decreased from 47% to 15% (P < .001), and the number of patients whose clinical specimens were culture positive also gradually decreased. A change in antibiotic use appears to have significantly affected our VRE outbreak when previous measures failed.

Ampicillin↗
PubMed1996

Treatment of experimental endocarditis due to multidrug-resistant Enterococcus faecium with clinafloxacin and penicillin.

Clinafloxacin, a new quinolone antibiotic with enhanced activity against Gram-positive bacteria, has demonstrated in-vitro activity against multidrug-resistant Enterococcus faecium, particularly when combined with penicillin. Rabbits with experimental endocarditis due to a multidrug-resistant strain of E. faecium were treated with clinafloxacin and/or penicillin. After three days of therapy, significant reduction of bacterial concentrations were found in vegetations, kidneys, and spleens of animals treated with clinafloxacin. The combination of clinafloxacin and penicillin was significantly better in reducing vegetation bacterial concentrations compared to the other groups (-4.4 log10 cfu/g compared with control). Serum levels of clinafloxacin consistently exceeded the MIC of the strain, and clinafloxacin-resistant isolates could not be detected. Clinafloxacin demonstrated promising activity in vivo against multidrug-resistant E. faecium, and further studies are warranted.

Animals↗
PubMed1996

Treatment of experimental endocarditis caused by multidrug resistant Enterococcus faecium with ramoplanin and penicillin.

Antibiotic resistant strains of enterococci are being isolated with increasing frequency. Effective treatment of infections caused by Enterococcus faecium resistant to ampicillin, vancomycin and aminoglycosides has not been established. We studied the activity of ramoplanin, a new lipoglycopeptide antibiotic, against two strains of multidrug resistant E. faecium. In time kill studies, ramoplanin was bactericidal against both strains, but not in the presence of 50% serum. The combination of ramoplanin and penicillin was bactericidal even in the presence of serum. In rabbits with experimental endocarditis neither penicillin nor ramoplanin significantly reduced vegetation colony counts when given alone, although ramoplanin significantly reduced spleen and kidney bacterial counts of both strains. The combination of ramoplanin plus penicillin resulted in a significant reduction of vegetation bacterial counts (-3.2 and -3.7 log10 cfu/g for strains VA3 and MMC3, respectively, P < 0.01). All spleen cultures and 9 out of 10 kidney cultures from each strain were sterile following combination therapy. While ramoplanin will not be available for parenteral therapy, further research into the development of other lipoglycopeptide antibiotics is warranted.

Animals↗
PubMed1996

Comparison of five selective media for identifying fecal carriage of vancomycin-resistant enterococci.

There is no uniformly accepted method for detecting colonization with vancomycin-resistant enterococci (VRE). The sensitivities of five culture methods were determined for patients known to harbor VRE. Of 189 inpatients, 101 were found to harbor VRE by at least one method. Three methods detected fewer than half of the cultures. Campylobacter agar identified 70% of patients. Enterococcosel broth (containing vancomycin and aztreonam) identified 88% and may be preferred over other media for routine surveillance.

Anti-Bacterial Agents↗
PubMed1996

In vitro activity of Cinnamomum zeylanicum against azole resistant and sensitive Candida species and a pilot study of cinnamon for oral candidiasis.

Fluconazole-resistant Candida species are an emerging problem. In this report, the in vitro activity of C. zeylanicum against fluconazole-resistant and-susceptible Candida isolates is described. The MICs of the bark of C. zeylanicum ranged from < 0.05-30 mg/ml, and were slightly better than commercially available cinnamon powder. Trans-cinnamaldehyde and O-methoxycinnamaldehyde had MICs of 0.03-0.5 mg/ml. The MICs of selected cinnamon candies and gums generally ranged from 25-100 mg/ml. Five patients with HIV infection and oral candidiasis received a commercially available cinnamon preparation for one week. There of the five patients had improvement of their oral candidiasis. Clinical trials will be necessary to determine the usefulness of cinnamon for the treatment of mucosal candidiasis.

Acrolein↗
PubMed1995

Ampicillin plus ciprofloxacin therapy of experimental endocarditis caused by multidrug-resistant Enterococcus faecium.

The combination of ampicillin and ciprofloxacin displayed bactericidal in-vitro activity against two strains of Enterococcus faecium which were highly resistant to ampicillin, vancomycin, and aminoglycosides. This antibiotic combination was used to treat rabbits with experimental endocarditis caused by these strains. Although a significant decrease in vegetation bacterial counts occurred with one strain, the degree of killing did not approach that of penicillin with an aminoglycoside against susceptible enterococci.

Ampicillin↗
PubMed1994

Use of pentoxifylline therapy for patients with AIDS-related wasting: pilot study.

Severe weight loss is a common manifestation of advanced infection with the human immunodeficiency virus. The level of tumor necrosis factor alpha (TNF-alpha), an inducer of cachexia in laboratory animals, is elevated in the serum of some patients with AIDS. In a pilot study, five patients with unexplained AIDS-related wasting were treated with pentoxifylline, a known suppressor of TNF-alpha production. Three of the five patients had elevated baseline serum levels of TNF-alpha, and these three patients did not have significant weight gain after 4-8 weeks of pentoxifylline therapy despite the reduction of serum TNF-alpha levels. The remaining two patients, who did not have elevated serum levels of TNF-alpha, continued to lose weight and developed extensive bacterial pneumonia within 3 weeks of starting pentoxifylline therapy. Thus, therapy with pentoxifylline did not clearly benefit the patients with AIDS-related wasting in this uncontrolled pilot study; indeed, it might have been harmful for a subgroup of these patients.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Treatment of experimental endocarditis due to multidrug resistant Enterococcus faecium with ciprofloxacin and novobiocin.

The effectiveness of ciprofloxacin and/or novobiocin therapy was assessed for experimental endocarditis caused by three strains of Enterococcus faecium resistant to ampicillin, vancomycin, and aminoglycosides. Rabbits with endocarditis caused by two of the strains had a significant decrease in bacterial counts in vegetations when treated with both antibiotics. Further studies using combination therapy with ciprofloxacin plus novobiocin for multidrug resistant strains of E. faecium are warranted.

Animals↗
PubMed1994

Bactericidal activities of peptide antibiotics against multidrug-resistant Enterococcus faecium.

Multidrug-resistant Enterococcus faecium has emerged as a serious pathogen for which no effective therapy has been established. In this report, we describe the activities of two peptide antibiotics, ramoplanin and daptomycin, against 15 isolates of E. faecium resistant to vancomycin, ampicillin, and aminoglycosides using time-kill experiments. Both antibiotics were rapidly bactericidal when tested in broth; however, the addition of 50% serum resulted in significant regrowth. The combination of ampicillin with either ramoplanin or daptomycin largely prevented this regrowth. These peptide antibiotics showed good activity against these pathogens. While the development of daptomycin has been halted, ramoplanin may hold promise for the therapy of multidrug-resistant E. faecium, especially when combined with ampicillin.

Ampicillin↗
PubMed1994

Activity of clinafloxacin against multidrug-resistant Enterococcus faecium.

Enterococci resistant to ampicillin, vancomycin, and/or aminoglycosides are a growing clinical problem. We studied the in vitro activity of the new fluoroquinolone clinafloxacin (PD 127,391) against 15 clinical isolates of multidrug-resistant Enterococcus faecium. In kill-kinetic studies, clinafloxacin (1 microgram/ml) was bactericidal against 7 of 12 susceptible isolates, although substantial regrowth occurred in 4 isolates at 48 h. The addition of ampicillin (20 micrograms/ml) resulted in bactericidal activity in all 12 isolates, and no regrowth was seen. For three isolates resistant to clinafloxacin, effective killing was not observed at these concentrations of antibiotics. Clinafloxacin with ampicillin shows promising activity against many of these multiply resistant enterococci.

Ampicillin↗
PubMed1993

Novel antibiotic regimens against Enterococcus faecium resistant to ampicillin, vancomycin, and gentamicin.

Enterococci have emerged as significant nosocomial pathogens. Enterococci with resistance to commonly used antibiotics are appearing more frequently. We encountered at our institution several infections caused by Enterococcus faecium with high-level resistance to ampicillin, vancomycin, and gentamicin. The optimal antibiotic therapy for serious infections with unusually resistant enterococci has not been established. Using time-kill studies, we tested the effectiveness of various antibiotic combinations against 15 isolates of multidrug-resistant enterococci. No antibiotic was consistently effective when used alone. The combination of ampicillin plus ciprofloxacin was bactericidal for the 12 isolates for which the ciprofloxacin MIC was < or = 8 micrograms/ml. The combination of ciprofloxacin plus novobiocin also demonstrated activity against these isolates. No combination was found to be bactericidal for the remaining three isolates, which were highly ciprofloxacin resistant. These antibiotic combinations may be important for the future treatment of serious infections caused by these resistant pathogens.

Ampicillin Resistance↗