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Biomedical subjects

E Abrutyn

Publications and source records attributed to E Abrutyn.

At least 37 records · Page 2Linked to original sources
PubMed1996

Immunoprophylaxis against klebsiella and pseudomonas aeruginosa infections. The Federal Hyperimmune Immunoglobulin Trial Study Group.

To determine if passive immunization could decrease the incidence or severity of Klebsiella and Pseudomonas aeruginosa infections, patients admitted to intensive care units of 16 Department of Veterans Affairs and Department of Defense hospitals were randomized to receive either 100 mg/kg intravenous hyperimmune globulin (IVIG), derived from donors immunized with a 24-valent Klebsiella capsular polysaccharide plus an 8-valent P. aeruginosa O-polysaccharide-toxin A conjugate vaccine, or an albumin placebo. The overall incidence and severity of vaccine-specific Klebsiella plus Pseudomonas infections were not significantly different between the groups receiving albumin and IVIG. There was some evidence that IVIG may decrease the incidence (2.7% albumin vs. 1.2% IVIG) and severity (1.0% vs. 0.3%) of vaccine-specific Klebsiella infections, but these reductions were not statistically significant. The trial was stopped because it was statistically unlikely that IVIG would be protective against Pseudomonas infections at the dosage being used. Patients receiving IVIG had more adverse reactions (14.4% vs. 9.2%).

Antibodies, Bacterial↗
PubMed1996

Does treatment of asymptomatic bacteriuria in older ambulatory women reduce subsequent symptoms of urinary tract infection?

OBJECTIVE: To determine whether treatment of symptomatic bacteriuria in older ambulatory women affects the subsequent development of symptoms of urinary tract infection. DESIGN: A controlled clinical trial. PARTICIPANTS: Older women not having urinary catheters. MEASUREMENTS: Urine cultures every 6 months (the same organism at 10(5) colony-forming units or more per mL on two midstream urine specimens defined asymptomatic bacteriuria) and questionnaire surveys for the new development of symptoms of urinary tract infection (dysuria, frequency, urgency, low back pain with fever) 1, 3, and 6 months after the initial survey. RESULTS: Of the 23 initially culture-positive participants receiving antibiotic treatment for symptomatic bacteriuria, nine were culture positive at 6 months, which contrasts with 18 of 27 who received no treatment or placebo, P = .05. However, symptoms of urinary tract infection were more common in the antibiotic-treated group. CONCLUSION: Antibiotic therapy effectively reduced the subsequent occurrence of positive urine cultures, but symptoms were not reduced. Based on this study of morbidity, previous studies failing to show any relation to mortality, and the cost and complications of antibiotic therapy in the older population, treatment of asymptomatic bacteriuria in older women is contraindicated.

Activities of Daily Living↗
PubMed1996

Antimicrobial resistance patterns in long term geriatric care. Implications for drug therapy.

There is a high prevalence of bacterial infections in long term care facilities (4.4 to 16.2%). This, together with the fact that antimicrobial resistance is a big concern in current medical practice, makes infection control so important in nursing home care. This article covers the mechanisms of antibacterial resistance and focuses on 4 major antibacterial-resistant bacteria. Vancomycin is the treatment of choice for methicillin-resistant Staphylococcus aureus (MRSA). Colonisation with MRSA is not uncommon in nursing homes and eradication is probably not necessary. Any clinically important enterococcal infection should be tested for high-level resistance. An infectious disease consultation should be sought for vancomycin-resistant enterococcal infections. Gram-negative bacilli have developed multi-resistance. Susceptibility testing can identify the most appropriate therapy. Multiresistance should also be considered when treating Streptococcus pneumoniae. Overall, handwashing is highly recommended. Barrier precautions, minimising hospitalisations and avoiding unnecessary personnel rotation can reduce the chance of resistance spread.

Aged↗
PubMed1996

Optimal treatment of urinary tract infections in elderly patients.

Elderly patients are at high risk for urinary tract infection (UTI). Infections of the urinary tract may be classified as asymptomatic bacteriuria, uncomplicated cystitis, uncomplicated pyelonephritis or complicated UTI. The micro-organisms responsible for causing UTI are largely predictable and dictate therapy when indicated. UTIs may be diagnosed by both nonculture and culture techniques. Asymptomatic bacteriuria, though quite common in the elderly, should rarely be treated. Treatment of symptomatic uncomplicated and complicated UTIs is largely dictated by the known or expected pathogen(s) and classification of the infection. Additional features affecting the treatment of UTI in the elderly include allergies, adverse reactions to therapy, drug interactions and modification for renal insufficiency.

Aged↗
PubMed1995

Incidence of infective endocarditis in the Delaware Valley, 1988-1990.

This population-based study aimed to determine the incidence of native, prosthetic, and bioprosthetic valve nosocomial infective endocarditis (IE), and IE associated with the use of injected drugs. Patients with IE during 27 months over the years 1988 to 1990, and residing in any of 6 counties in the Philadelphia metropolitan area were identified. An expert panel reviewed all patients to verify the diagnosis. Incidence rates were estimated after adjustment for failure to recruit and underreporting. Of 853 potential patients, 670 (79%) met the inclusion criteria. The overall incidence rate of IE was 11.6 cases/100,000 person-years (95% confidence interval [CI] 10.8 to 12.4). The rates for specific types of IE were: 4.45 (95% CI 3.97 to 4.94) for community-acquired native valve, 0.94 (95% CI 0.72 to 1.12) for prosthetic valve, 0.94 (95% CI 0.71 to 1.16) for nosocomial, and 5.34 (95% CI 4.80 to 5.87) for IE associated with use of injected drugs. Previous population studies found overall incidence rates of 1.7 to 4 cases/100,000 person-years, similar to our rate for community-acquired native valve IE. Type-specific rates have not been previously reported. The higher overall rate in this study is partly related to the high prevalence of injection drug use in our area.

Adult↗
PubMed1995

Developing policies and guidelines.

Practice guidelines are proliferating in the era of managed care. Hospital epidemiologists frequently are asked to author guidelines of infection control. The greatest challenge in the process is not writing the guidelines but implementing them. This article offers practical advice on which topic to select and on how to develop and implement guidelines.

Cost Control↗
PubMed1995

Time to peak serum antibody response to influenza vaccine.

The time to the appearance of a peak serum antibody response to influenza virus vaccine is not clearly defined. We compared the most commonly used time intervals described in the literature--4 and 6 weeks after vaccination. We studied 118 elderly patients from three different geographic sites. The 1992 to 1993 trivalent inactivated influenza virus vaccine containing influenza virus A/Beijing/353/89 (H3N2), influenza virus A/Texas/36/91 (H1N1), and influenza virus B/Panama/45/90 was used. No statistically significant differences were found at the 4- and 6-week intervals after vaccination.

Aged↗
PubMed1995

Pathogens resistant to antimicrobial agents. Epidemiology, molecular mechanisms, and clinical management.

The emergence of resistance to antimicrobial agents continues to be a major problem among both nosocomial and community-acquired pathogens. Bacteria employ a variety of strategies to avoid the inhibitory effects of antibiotic agents, and have evolved highly efficient means for the dissemination of resistance traits. The result has been the emergence of multidrug-resistant pathogens such as penicillin-resistant pneumococci, vancomycin-resistant enterococci, methicillin-resistant staphylococci, as well as a variety of multiresistant gram-negative organisms. Control of antibiotic-resistant pathogens will provide a major challenge for both the medical community and society in general. The implication of a failure to meet this challenge is the eventual arrival of the "post antibiotic era."

Bacteria↗
PubMed1994

Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women?

OBJECTIVE: To determine whether asymptomatic bacteriuria in elderly ambulatory women is a marker of increased mortality and, if so, whether it is because of an association with other determinants of mortality or because asymptomatic bacteriuria is itself an independent cause, the removal of which might improve longevity. DESIGN: A cohort study and a controlled clinical trial of the effect of antimicrobial treatment. SETTING: A geriatric center and 21 continuing care retirement communities. PARTICIPANTS: Women without urinary tract catheters. MEASUREMENTS: Urine cultures every 6 months (the same organism at 10(5) colony-forming units or more per mL on two midstream urine specimens defined asymptomatic bacteriuria), comorbidity, and mortality. RESULTS: In the observational study, infected residents (n = 318) were older, and sicker, and had higher mortality (18.7 per 100,000 resident-days) than uninfected residents (n = 1173; 10.1 per 100,000 resident-days). However, in a multivariate Cox analysis, infection was not related to mortality (relative risk, 1.1; P > 0.2), whereas age at entry and self-rated health (score 1 [excellent] to 4 [bad or poor]) were strong predictors. In the clinical trial, mortality in 166 treated residents (13.8 per 100,000 resident-days) was comparable to that of 192 untreated residents (15.1 per 100,000 resident-days); the relative rate was 0.92 (95% CI, 0.57 to 1.47). The cure rates among treated and untreated residents were 82.9% and 15.6%, respectively. CONCLUSION: Urinary tract infection was not an independent risk factor for mortality, and its treatment did not lower the mortality rate. Screening and treatment of asymptomatic bacteriuria in ambulatory elderly women to decrease mortality do not appear warranted.

Aged↗
PubMed1994

Assessing diagnostic criteria for active infective endocarditis.

A study was performed to describe agreement among experts on their classification of patients, in the absence of information concerning risk factors, as to the presence of infective endocarditis (IE). The study also assessed the clinical characteristics that enabled the experts to determine that a patient had IE. All patients with a discharge diagnosis of IE were identified prospectively from 54 hospitals in the Delaware Valley over a 3-year period. Patients were part of a case-control study of risk factors for IE. Three infectious disease experts independently reviewed abstracted hospital records and classified each of 151 eligible patients as a definite, probable or possible case, or a probable noncase, both based on clinical judgement and using a modified standard definition. Experts were more likely to classify a patient as a definite case of IE on the basis of clinical judgement than by using the modified standard definition. Agreement between reviewers was 92 to 95% when they were distinguishing only probable non-cases from others. Agreement between reviewers on specific categories was lower (40 to 58%). The number of positive blood cultures was a strong predictor of a patient's being classified as a case, as was the type of infecting organism. It is concluded that experts are willing to make a definitive diagnosis of IE on the basis of blood culture information alone. Further supporting evidence, such as the presence of vegetation on an echocardiogram, is needed when blood culture results are ambiguous.

Adult↗
PubMed1993

Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment: an 18-month prospective follow-up.

Our objective was to determine the prevalence and incidence of human immunodeficiency virus (HIV) infection and related risk behaviors among opiate-abusing intravenous drug users (IVDUs) either in or out of methadone treatment. The subjects, 152 in-treatment and 103 out-of-treatment intravenous opiate users, were followed prospectively for 18 months. Behavioral and serologic assessments were made at 6-month intervals, with complete information available on 89% of the sample. Subjects were recruited from a single methadone maintenance program and the surrounding neighborhood in north-central Philadelphia. At baseline, the HIV seroprevalence rate for the total sample was 12%: 10% for the methadone-maintained group and 16% for the out-of-treatment group. Out-of-treatment subjects were injecting drugs, sharing needles, visiting shooting galleries, and practicing unsafe sex at significantly higher rates than in-treatment subjects. Follow-up of HIV-negative subjects over the next 18 months showed conversion rates of 3.5% for those who remained in methadone maintenance versus 22% for those who remained out of treatment. The sixfold difference in rate of seroconversion between the two groups suggests that although rapid transmission of HIV still occurs, opiate-abusing IVDUs who enter methadone treatment are significantly less likely to become infected. In contrast, those opiate addicts who do not enter treatment are at significantly higher risk of contracting and spreading the disease. Implications for developing additional risk interventions for out-of-treatment IVDUs are discussed.

Adult↗
PubMed1991

Urinary tract infection: economic considerations.

Urinary tract infection results in significant morbidity and mortality while consuming large amounts of national resources. The prevention, diagnosis, and treatment of urinary tract infection produce both costs and benefits, and economic analysis provides a rational framework for looking at these effects. The goals and methods of economic analysis in medicine are summarized, and strategies to address uncomplicated cystitis, nosocomial urinary tract infection, and pyelonephritis are reviewed, with an emphasis on the economic trade-offs faced by decision makers.

Acute Disease↗
PubMed1991

Epidemiology of asymptomatic bacteriuria in elderly women.

We studied asymptomatic bacteriuria in elderly ambulatory women residents without indwelling catheters in self-contained apartment houses at the Philadelphia Geriatric Center (PGC), in the nursing home at PGC, and in several life-care communities (LCC). Subjects were studied every 6 months from January 1983 through January 1989, and since enrollment was continuous some participated in more surveys than others. PGC residents were middle class and lived either in a self care apartment house (CL) or nursing home (NH); LCC residents were middle or upper class. Antimicrobial therapy for asymptomatic bacteriuria was not given by the study team. The ages of the 865 women studied averaged 80.3, 82.8, and 83.3 years in LCC, CL, and NH, respectively. On each survey about 11% at LCC, 18% at CL, and 25% at NH sites had positive cultures. Turnover was high. The conversion rate from a negative to a positive culture was 5% at LCC, 11% at CL, and 8% at NH. The reversion rate from a positive to a negative culture was 33% at LCC, 34% at CL and 31% at NH (P greater than 0.05). Persistent infection with the same organism was uncommon. Infection risk was associated with residence, which was partially explained by a factor evaluating mobility, but was unrelated to age or scores evaluating activities of daily living or mental status. Besides mobility, other more complex factors play a role in the acquisition of infection.

Activities of Daily Living↗