Search PubMed⌕ Search

Biomedical subjects

D R Graham

Publications and source records attributed to D R Graham.

71 records · Page 4Linked to original sources
PubMed1981

Epidemic nosocomial meningitis due to Citrobacter diversus in neonates.

Five infants born at one hospital over a two-year period developed meningitis due to a serotype O2 strain of Citrobacter diversus; four infants developed brain abscesses due to this organism. The initial prevalence of stool colonization in infants was 79%; eventually 140 infants (10%) and six nurses (6%) were found to be colonized. One colonized infant remained in the hospital for the entire two-year period. The strains were of two biotypes marked by the presence (biotype d) or absence (biotype a) of fermentation of sucrose and dulcitol. The biotype d strain was found in the five infants with meningitis, 110 asymptomatic infants, and five nurses. The biotype a strain, which was isolated from 30 infants and one nurse, did not cause disease. Colonized infants were distinguished by intensive care therapy (P = 10-31), gavage feeding (P = 0.036), and prenatal intrauterine monitoring (P = 0.037). These findings suggest a fecal reservoir and person-to-person transmission of C. diversus. Measures to control the outbreak cost about $110,000.

Birth Weight↗
PubMed1981

Rapid presumptive identification of Citrobacter diversus as an aid in controlling infections.

During an outbreak of neonatal meningitis caused by kanamycin-resistant Citrobacter diversus, a field procedure for presumptive identification of the organism was evaluated, and using it resulted in the early recognition of patients colonized by the epidemic strain of C. diversus. Rectal and nasopharyngeal specimens were plated and incubated on MacConkey agar containing 10 micrograms of kanamycin per ml. After 18 h of incubation, lactose-nonfermenting colonies present on the selective medium were picked and identified 8 h later with the following biochemical tests: indole, adonitol, dulcitol, citrate, and triple sugar iron agar. This presumptive identification of C. diversus was later confirmed for all cases by conventional testing with a complete set of biochemicals. In 1 week, 253 specimens from patients were processed with this technique, and 49 strains of C. diversus were identified. The rapid identification of C. diversus and transfer of carriers into appropriate cohorts resulted in a 64% reduction in the prevalence of colonization.

Bacteriological Techniques↗
PubMed1981

Cutaneous inflammation caused by inadvertent intradermal administration of DTP instead of PPD.

In 1979, 101 adults were skin-tested by a health department to evaluate tuberculin reactivity; of the 96 persons followed, 87 (91 per cent) experienced inflammation marked by swelling, erythema, arm pain, and fever. Five months later, a 5 mm to 10 mm purple macule persisted in 76 persons. The vials of PPD reportedly used for testing had been discarded, but PPD had been stored in the refrigerator with DT and DTP. The mean tetanus antitoxin titer in skin-tested persons was 0.14 units per ml (u/ml) vs 0.08 u/ml in untested control persons (p lesser than 0.03). The mean diphtheria antitoxin titer in skin-tested people was 0.90 u/ml vs 0.16 for controls (p = 10(-5)). The mean pertussis antibody in skin-tested persons was 1:169 vs 1:12 for controls (p = 10(-5)). Intradermal DTP in immune rabbits produced histologically typical Arthus reactions similar to those experienced by the humans. Seven months later, 90 persons received PPD injections. Ten had induration; none experienced persistent reactions. We concluded that the humans initially received DTP instead of PPD.

Animals↗
PubMed1981

An outbreak of pseudobacteremia caused by Enterobacter cloacae from a phlebotomist's vial of thrombin.

In a 15-day period, seven patients in a small hospital each had one blood culture positive for Enterobacter cloacae. None of the seven patients was septic. All seven positive culture specimens had been obtained by phlebotomist A, who also had obtained 13 negative culture specimens in the same period. Seven other phlebotomists had drawn 69 blood samples for culture during the same period; none had yielded any microorganism (p = 0.00001). Vials of thrombin, routinely used to coagulate blood specimens for chemical analysis, had been carried on the phlebotomy trays. We observed that phlebotomist A occasionally spilled drops of the viscous thrombin on her finger during the procedures. Culture of the thrombin on her tray yielded E. cloacae. No further cases of E. cloacae bacteremia occurred after she stopped drawing blood for culture and the thrombin on her tray was removed from use.

Blood Specimen Collection↗
PubMed1980

Epidemic neonatal gentamicin-methicillin--resistant Staphylococcus aureus infection associated with nonspecific topical use of gentamicin.

One hundred sixteen infants in an intensive care nursery acquired Staphylococcus aureus resistant to gentamicin and methicillin; 54 patients acquired S. aureus sensitive to gentamicin and methicillin. Topical application of gentamicin ointment was significantly associated with acquisition of GMRS. Of 78 infants who acquired GMRS, 38 had received GmO before GMRS was first cultured, whereas only one of 49 infants with GMSS had previously received GmO (P = 8.6 X 10(-8)). Infants with GMRS were also more likely than patients with GMSS to have had a lower mean birth weight, Apgar score, and gestational age; systemic antibiotic therapy and incubator care were significantly prolonged for patients with GMRS, but these factors did not explain susceptibility to GMRS infection. Multivariate logistic regression analysis showed that use of GmO was the single most important risk factor.

Bacteriological Techniques↗
PubMed1979

Guidelines for the care of patients hospitalized with viral hepatitis.

For years patients hospitalized with viral hepatitis have been placed in two categories of isolation--enteric precautions and blood precautions. This strategy was based on the inability to differentiate between hepatitis A and B and on the assumption that feces and blood from patients with either type might be infective. It is now known that patients with hepatitis A do not pose a problem of disease transmission through direct contact with blood, and although blood of patients with hepatitis B may be infective, the virus is not transmitted via feces. The enteric route is the principal mode of transmission for hepatitis A, but maximal levels of hepatitis A virus excretion occur before the onset of jaundice. Non-A, non-B hepatitis is similar epidemiologically to hepatitis B. Thus, the major thrust for caring for patients hospitalized with viral hepatitis is toward blood precautions; the same precautions used when handling feces, urine, and excretions from all other hospitalized patients are appropriate for patients admitted with a diagnosis of hepatitis A.

Bedding and Linens↗
PubMedDate not supplied

Gentamicin treatment associated with later nosocomial gentamicin-resistant Serratia marcescens infections.

During a hospital epidemic of infections with gentamicin-resistant Serratia marcescens (GRS), we studied the relation between receiving antibiotics and acquiring GRS. In a five-month period, 22 patients acquired GRS, whereas 18 patients acquired gentamicin-sensitive Serratia (GSS). When compared with patients with nosocomial GSS infection, patients with nosocomial GRS had been in the hospital (p = 0.04) and the intensive care unit (p = 0.003) longer before infection and more had received gentamicin (p = 0.001) or ampicillin (p = 0.02) before infection. To control for the influence of underlying disease, we matched all 12 ICU patients with GRS infection and 12 patients without GRS infection for underlying illness and duration of intensive care. Use of any antibiotic (p = 0.04), or a combination of gentamicin plus ampicillin or cephalosporin (p = 0.047) was more common among patients with GRS infection. The hospital had not significantly increased the use of aminoglycosides from the previous year. We conclude that for the individual patient antimicrobial therapy, especially with gentamicin or ampicillin, creates a risk for later infection by GRS that is independent of the severity of the underlying illness.

Aged↗
PubMedDate not supplied

Infections caused by Moraxella, Moraxella urethralis, Moraxella-like groups M-5 and M-6, and Kingella kingae in the United States, 1953-1980.

From 1953 to 1980 the Centers for Disease Control received 933 isolates of bacteria belonging to species of the genus Moraxella, Moraxella-like Moraxella urethralis, now renamed Oligella urethralis, unnamed groups M-5 and M-6, and Kingella kingae. Ordinarily sterile sites were the source of 233 isolates. Moraxella nonliquefaciens, the most common isolate (356 strains), was recovered from upper respiratory or ocular sites in 208 (58%) of the cases. Moraxella osloensis was next most common (199 strains) but was the most frequent blood isolate (44 cases). K. kingae appeared especially invasive, with 58 of 78 isolates from blood, bone, or joint. Of the K. kingae strains, 75% were recovered from children under 6 years, compared with 23% of the other strains from that age group (P less than .01). Of the 74 isolates of group M-5, 53 were from wounds caused by dog bites; no other organism in this series was recovered from such wounds. Sixteen of the 28 M. urethralis isolates were from urine. Cases occurred as single infections, with no evidence of clusters. Of patients with infection of ordinarily sterile sites, 9.3% died; only bacteremia, meningitis, and empyema caused fatalities. Most referring laboratories (98%) had not identified the organisms to species, and only 30% had identified them to correct genus. Susceptibility testing by broth dilution revealed low MICs of penicillin (mean, 0.3; 64% less than 1 micrograms/mL). Moraxella, M. urethralis, M-5, M-6, and Kingella are important but frequently misidentified pathogens for humans; penicillin appears to be the treatment of choice.

Adult↗
PubMedDate not supplied

Susceptibility testing of topical antibacterials against methicillin-resistant Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) isolates that were collected from 44 consecutive patients during 1 year in a community hospital were tested for susceptibility to five commonly used topical antibacterial agents. Agar-well susceptibility testing, which was based on zones of inhibition, was used to compare the effectiveness of the antibacterials against MRSA. Nitrofurazone was effective in inhibition of bacterial growth and was relatively inexpensive. Mupirocin was found to be effective but more costly for treatment of MRSA. Varying degrees of susceptibility to silver sulfadiazine, mafenide acetate, and bacitracin were noted in the cultures that were obtained at this medical center. On the basis of our findings from susceptibility tests compared with those of another center, we recommend that all hospitals undertake topical sensitivity testing of their MRSA isolates. Appropriate and effective topical antibacterial therapy can then be planned within each center.

Anti-Infective Agents, Local↗
PubMedDate not supplied

Development of septic arthritis by hematogenous seeding in a pediatric patient with burns.

We describe a pediatric patient with burns who experienced a septic hip joint from hematogenous seeding by sustained Staphylococcus aureus bacteremia. A search for a central vascular focus of the bacteremia included the use of an indium scan, which localized purulence within the left hip joint. The physical findings, radiographic findings, and subsequent aspiration of the hip joint were diagnostic for a septic arthritis. This case alerts the physician that the pediatric hip is a potential site for infection in the presence of bacteremia. Once infected, the joint may become a secondary source of an ongoing bacteremia. The diagnostic work-up and treatment for a septic hip have been discussed. This occult site of infection is easy to overlook because a painful hip joint in the pediatric patient with burns may be confused for painful burn wounds. The prerequisites to joint infections in this population were all present: bacteremia, intercurrent illness, unique vascular anatomy, and an impaired immune response.

Arthritis, Infectious↗
PubMedDate not supplied

Overwhelming postsplenectomy sepsis in a patient with burns: a case report and a rational approach to treatment.

Overwhelming postsplenectomy sepsis is a dreaded sequel of splenectomy. The rate of overwhelming sepsis in children after splenectomy for trauma is reported to be 10 to 30 times that of the general population. Episodes of pneumonia, septicemia, and meningitis in adults after a splenectomy are 166 times more common than in the general population. The care of a patient with burns and asplenia presents many unique management challenges to the burn physician. Awareness of the development of overwhelming postsplenectomy sepsis and its most common infecting organisms is crucial. The specific immunologic deficiencies of reduced immunoglobulin production and cell-mediated immunity that exist in patients after a splenectomy may be compounded by burn injury. Specific treatment recommendations for patients with burns and asplenia are lacking. We report a fatal case of overwhelming sepsis in a patient with asplenia and with an 8% total body surface area partial-thickness burn, and we review the pathogenesis of overwhelming postsplenectomy sepsis. We focus on treatment recommendations regarding the use of prophylactic antimicrobials, intravenous immunoglobulin replacement therapy, and pneumococcal polyvalent vaccine to standardize the care of the patient with burns and asplenia and reduce infectious morbidity and deaths.

Adult↗
PubMedDate not supplied

Low cost surgical drill.

A low cost cordless electric drill originally designed for the home workshop has been adapted for use in the operating room and extensively employed for over a year. Permitting one-hand operation, unencumbered by power cords or air hoses, and positively free from shock hazard, this type of drill will perform the majority of drilling tasks needed by the orthopedic surgeon. The cost compares with many currently used "disposable" operating room items.

Bone Diseases↗