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Biomedical subjects

D W Bentley

Publications and source records attributed to D W Bentley.

At least 37 records · Page 2Linked to original sources
PubMed1990

Infection control in the nursing home: the physician's role.

Infection control in the nursing home or long-term care facility is an increasingly complex activity. The high rates (approximately 15%) and special risks (group activities, crowding) for nosocomial infection demand special attention by attending physicians. Some specific responsibilities include: recognition of infection; knowledge and use of basic infection control principles; appropriate antibiotic use; review of immunizations; facilitation of communications among office, hospital, and long-term care facility; and involvement with infection control program(s).

Allied Health Personnel↗
PubMed1987

Immune response of elderly adults to pneumococcus: variation by age, sex, and functional impairment.

The immune response of 271 elderly persons to the new 23-valent pneumococcal vaccine was studied prospectively. Sera were obtained prevaccination, at 1 month post- and 12 months postvaccination. They were analyzed by radioimmunoassay for the presence of antibody Types 1, 3, 6A, 7F, 8, and 9N. The results showed differences in antibody levels by sex of the individual (p less than .01 pre and p = .04 at 1 month post), with women having lower antibody levels than men. Women responded better to vaccination than men (p = .05), but they also lost their acquired antibodies faster (p less than .01). No age effect and no effect of level of functioning were observed within this group of elderly individuals. Participants who died had high initial levels and responded well. Major differences between the six types were noticed. Type 6A exhibited the described pattern most clearly, whereas Type 3 often behaved in an opposite pattern from the other five types. We conclude that sex differences persist even among elderly adults, that high levels of antibodies are not necessarily an indicator of good health, and that much unexplained variation between antibody types exist.

Aged↗
PubMed1986

Systemic antibiotic use in nursing homes. A quality assessment.

In this evaluation of the prevalence and quality of systemic antibiotic use in nursing homes, 42 skilled nursing facilities (SNFs) and their 11 attached intermediate care facilities (ICFs) were surveyed. A random sample of 2238 patients (51%) from the total of 4378 beds was selected and of these, 7.7% of the total (8.6% of the SNF and 4.5% of the ICF) patients were on systemic antibiotics on the day of the survey. The most common suspected sites of infection were urinary tract (58.4%), lower respiratory tract (19.1%), and skin or subcutaneous tissue (4.6%). Criteria for appropriateness of initiating systemic antibiotics, for adequacy of initial diagnostic workup, and for appropriate specific antibiotics were developed by the authors, with input from a group of medical directors of nursing homes, based on Centers for Disease Control and Federal Drug Administration guidelines. Evidence to start an antibiotic was judged adequate in 62.4% of cases. Workups were considered inadequate in a high proportion of cases. For example, urinalysis was ordered in only 23.8% and urine culture in 57.4% of suspected urinary tract infections; chest x-ray was ordered in 24.2% and sputum culture in 3.0% of suspected lower respiratory infections. Recommendations are made as to minimum adequate workup for suspected infections and appropriate evidence to justify start of a systemic antibiotic, recognizing the limitations in diagnostic modalities in the nursing home setting and the special problems of their resident populations.

Aged↗
PubMed1985

Comparison of latex agglutination and counterimmunoelectrophoresis for the detection of pneumococcal antigen in elderly pneumonia patients.

A Streptococcus pneumoniae latex agglutination (LA) test (Bactigen; Wampole Laboratories, Div. Carter-Wallace, Inc., Cranbury, N.J.) and counterimmunoelectrophoresis (CIE) were compared for the detection of pneumococcal antigen in serum and urine specimens from 68 elderly patients with pneumococcal pneumonia. The cases were categorized according to the presumptive role of S. pneumoniae: definite, putative, questionable (poor score), or questionable (mixed flora). Serum and urine samples were collected on days 1 to 3, 4 to 6, and 7 to 9 of illness and screened in parallel by LA and CIE. LA detected pneumococcal antigen in the serum or urine or both from 31 (46%) of the 68 pneumococcal pneumonia cases compared with 10 (15%) of cases detected by CIE. The highest rates of detection were noted in the 17 definite (bacteremic) cases: 88% by LA and 38% by CIE. The detection rates for both tests were lower in the other nonbacteremic pneumonia categories. Pneumococcal antigen was detected more often in urine specimens than in serum specimens by LA and CIE and was detected in the urine of 92 and 46% of definite cases, respectively, after 7 to 9 days of illness despite antibiotic therapy. Both tests were specific when tested with nonpneumococcal pneumonia cases, but LA detected pneumococcal antigen in two of seven chronic bronchitis cases. This study suggests that LA is as specific and more sensitive than CIE and is useful for detecting antigen in the elderly with proven bacteremic pneumococcal pneumonia. LA is less sensitive for detecting nonbacteremic pneumococcal pneumonia and, therefore, would be of limited value in the care and study of the institutionalized elderly.

Aged↗
PubMed1984

Bacterial pneumonia in the elderly: clinical features, diagnosis, etiology, and treatment.

Diagnosis of bacterial pneumonia in the elderly depends on an awareness of the various forms of presentation and identification of the etiologic agent(s). The reliability of sputum or nasopharyngeal aspirates can be assessed by the number of squamous epithelial cells and white blood cells per 100 X field (low-power). Transtracheal aspiration should be considered in select patients with life-threatening pneumonias. Community-acquired pneumonias are caused primarily by S. pneumoniae (40-60%), hospital-acquired pneumonias by gram-negative bacilli (45%) and institution-acquired pneumonias by mixed flora (35%) and S. pneumoniae (30%). Initial choice of antimicrobial agents is based on an interpretation of the Gram stain. Choice of empiric antimicrobial treatment depends on host characteristics and the setting in which the pneumonia occurs.

Aged↗
PubMed1981

Influenza A/Brazil/78(H1N1) infection in the elderly.

Although influenza A/H1N1 virus has caused both sporadic illness and epidemics throughout the world, there have been few cases and no outbreaks reported in older persons. Using a surveillance program for detection of viral respiratory tract illness, we documented an outbreak of influenza (A/Brazil/78(H1N1) infection in one floor of a chronic disease hospital. We prospectively studied all 32 patients and 16 personnel on that floor. Infection was proved in 11 subjects by serology and/or virus isolation, including 9 patients (median age, 84 yr) and 2 personnel (36 and 58 yr of age), for attack rates of 28% and 12.5%, respectively. Six patients had fever, 38 degrees C to 39 degrees C, lasting for 1 to 5 days (median, 4), and/or respiratory and constitutional symptoms lasting for 2 to 17 days (median, 13). Bacterial pneumonia occurred in 1 patient 12 days after the onset of upper respiratory tract illness. Risk factors for acquisition of infection in patients included a nonvaccinated state (p = 0.03) and a preinfection antibody titer of less than or equal to 32 (p = 0.02). These findings indicate that older persons are at risk for infection with influenza A/H1N1 virus, which may also cause outbreaks of respiratory illness in the elderly institutionalized population similar to other influenza viruses.

Adult↗
PubMed1980

Anaerobic urinary tract infection owing to Bacteroides fragilis in a chronic hemodialysis patient.

A chronic maintenance hemodialysis patient with severe oliguria and persistent anaerobic urinary tract infection owing to Bacteroides fragilis is presented. Review of the literature shows that the incidence of anaerobic pathogens in random urine cultures is high but that the incidence of clinically significant infection is low. Since the urethra harbors anaerobic organisms suprapubic aspiration of urine and culture are indicated to confirm true anaerobic urinary tract infection. Anaerobic infections are associated with urinary tract abnormalities and pyuria. The various therapeutic maneuvers that were used to treat the infection are discussed, including antibiotic instillation into the bladder and nephrectomy.

Bacteroides Infections↗
PubMed1980

Concurrent respiratory syncytial virus and influenza A infections in the institutionalized elderly and chronically ill.

During a community outbreak of respiratory syncytial virus and influenza A/Texas/77 infections, we investigated 71 cases of upper respiratory illness at a chronic disease hospital using a surveillance system plus viral and serologic studies. Of the 32 patients with an etiologic diagnosis, seven had respiratory syncytial virus, 24 had influenza, and one had dual infections with respiratory syncytial virus and influenza. No definite etiologic diagnosis was made in the remaining 39 patients. A comparison of the clinical features of patients infected with respiratory syncytial virus and influenza revealed no significant differences in the frequency of respiratory or constitutional signs and symptoms except for rhinorrhea, which was commoner in the respiratory syncytial virus group (P less than 0.05). Pneumonia developed in one patient with respiratory syncytial virus and in five patients with influenza. Our findings suggest that respiratory syncytial virus may be an important respiratory pathogen for the elderly and chronically ill, causing illness similar to influenza.

Aged↗
PubMed1978

Factors predisposing to oropharyngeal colonization with gram-negative bacilli in the aged.

To assess the factors responsible for oropharyngeal colonization with gram-negative bacilli among elderly persons in institutions, we performed a cross-sectional survey of 407 volunteers, 65 years of age and older, who had not received antimicrobials in the previous four weeks. Colonization increased with level of care: from 9 per cent in independent residents of apartments to 60 per cent in patients on an acute hospital ward (P less than 0.0001). Klebsiella species was found in 41 per cent of those with colonization, Escherichia coli in 24 per cent and enterobacter species in 14 per cent. There was no association between numbers of normal flora and numbers of gram-negative bacilli. Associated with colonization were bladder incontinence, deteriorating or terminal clinical status, inability to walk or perform activities of daily living and incapacitation due to neoplastic, respiratory and cardiac disease (P less than 0.05). Multivariate analysis indicated that respiratory disease and being bedridden contributed most to colonization.

Activities of Daily Living↗
PubMed1978

Type-specific pneumococcal respiratory disease in the elderly and chronically III.

Type-specific pneumococcal respiratory disease was studied in a chronic-disease hospital during a 27-month period. Isolates from 50 patients with pneumonia and from 24 patients with chronic bronchitis were available for typing. Vaccine types were isolated from 74 per cent of patients with pneumonia and from 42 per cent of patients with chronic bronchitis. Pneumococcal types isolated from 5 of 8 patients with bacteremia and from 6 of 9 patients who died were also included in the vaccine. The data suggest that, theoretically, closed populations of elderly and chronically ill patients would benefit from vaccination in an attempt to control pneumococcal pneumonia. Less clear is the potential role vaccination in patients with chronic bronchitis.

Antigens, Bacterial↗
PubMed1977

Responses of elderly and chronically ill subjects to bivalent influenza A/New Jersey/8/76 (Hsw1N1)-A/Victoria/3/75 (H3N2) vaccines.

Antibody responses and side effects to bivalent influenza A virus vaccines from three different manufacturers, containing 200 or 400 chick cell-agglutinating (CCA) units each of A/New Jersey/8/76 (Hsw1N1) and A/Victoria/3/75 (H3N2) antigens, were evaluated in 234 ambulatory elderly and chronically ill volunteers in a placebo-controlled, doubld-blind study. Systemic reactions did not occur significantly more often among recipients of vaccine than among volunteers who received placebo. Local reactions to vaccines were observed but were mild, transient, and well tolerated. Occurrence of preexisting antibody to each antigen was common. Titers of antibody to A/New Jersey/8/76 (Hsw1N1) antigen of greater than or equal to 1:40 occurred after immunization in 94%-100% of volunteers receiving vaccines and in 66% of the placebo recipients. Titers of antibody to A/Victoria/3/75 (H3N2) antigen of greater than or equal to 1:40 occurred in 53%-85% of vaccine recipients compared with 34% of those in the placebo group. Thus, bivalent split-product and whole-virus influenza I vaccines containing 200/200 or 400/400 CCA units of the two antigens appeared to be nearly equivalent in incidence and severity of side effects and antibody responses in recipients.

Adult↗
PubMed1976

Malignant external otitis: a severe form of otitis in diabetic patients.

Two cases of malignant external otitis are presented and the literature is reviewed. The disease seems to occur exclusively in elderly diabetic patients. Diagnosis is mostly a clinical one, and requires a high index of suspicion. The characteristic clinical manifestations are pain and severe tenderness of the tissues around the ear and mastoid, persistent drainage and the presence of granulation tissue at the junction of the osseus and cartilagenous portions of the external ear. Roentgenographic findings are not helpful in the early stages. The pathogenesis of this disease depends on the presence of clefts in the cartilage forming the floor of the external auditory canal at its junction with the osseus portion through which infection can spread from the external ear to the deep soft tissues. Serious and often fatal complications may ensue. The most common and earliest symptom to appear if facial nerve palsy. Pseudomonas aeruginosa has been isolated uniformly, in pure or mixed cultures. This entity, therefore, should be borne in mind whenever an elderly diabetic patient presents with external otitis not amenable to the usual methods of therapy. Ps. aeruginosa should be strongly suspected, and its isolation should prompt vigorous systemic treatment with gentamicin and carbenicillin before extensive necrosis of cartilage and bone takes place. Any delay in diagnosis and management will lead to a serious and often fatal complications.

Age Factors↗
PubMed1976

Evaluation of a temperature-sensitive influenza virus in elderly and chronically ill subjects.

A temperature-sensitive influenza virus, influenza A/Hong Kong/68-ts-1 (E), was administered to 18 elderly subjects and to 18 chronically ill subjects. Clinical reactions were infrequent (n = 3), mild, and afebrile. Vaccine virus was recovered from 5 subjects. Serum-neutralizing antibody responses to A/Hong Kong/68 antigen were detected in 13. Serum hemagglutination inhibiting antibodies were detected in 6 to A/Hong Kong/68 antigen and in 7 to A/England/42/72 antigen. Nasal antibodies were detected in 3. Using any criteria, a total of 17 patients developed evidence of infection, and occurrence of infection was related to concentration of serum antibody before inoculation. Transmission of vaccine virus may have occurred to one of 10 uninoculated subjects. In the presence of a naturally occurring outbreak of influenza A/England/42/72, 15 ts-1 (E) vaccines and 17 of 42 persons who had received parenteral vaccine became ill. Evidence of infection with influenza virus was obtained in 8 of the former and 10 of the latter group.

Adult↗