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Biomedical subjects

F A Sarubbi

Publications and source records attributed to F A Sarubbi.

At least 19 recordsLinked to original sources
PubMed2000

The epidemiology of mupirocin resistance among methicillin-resistant Staphylococcus aureus at a Veterans' Affairs hospital.

OBJECTIVE: To describe the clinical and molecular epidemiology of mupirocin-resistant (MR) and mupirocin-susceptible (MS) methicillin-resistant Staphylococcus aureus (MRSA) at a Veterans' Affairs hospital and to assess risk factors associated with the acquisition of MR MRSA. DESIGN: All clinical MRSA isolates for the period October 1990 through March 1995 underwent susceptibility testing to mupirocin. Mupirocin resistance trends were measured, and MS MRSA and MR MRSA isolates underwent typing by pulsed-field gel electrophoresis (PFGE). A retrospective case-control study was conducted to evaluate risk factors for having MR versus MS MRSA. SETTING: The James H. Quillen Veterans' Affairs Medical Center in Mountain Home, Tennessee, included a 324-bed acute-care hospital, a 120-bed nursing home, and a 525-bed domiciliary. Colonizations and infections with MRSA were endemic, and mupirocin ointment was commonly used. PATIENTS: Inpatients and outpatients at the facility. RESULTS: MS MRSA was recovered from 506 patients and MR MRSA from 126. Among MR MRSA isolates, 58% showed low-level mupirocin resistance (minimum inhibitory concentration [MIC] > or = 4 to 256 microg/mL), and 42% showed high-level mupirocin resistance (MIC > or = 512 microg/mL). A significant increase (P=.002) in the number of high-level MR isolates occurred during the 1993 to 1995 period. A case-control study showed that presence of a decubitus ulcer correlated with high-level resistant isolates (P<.05). The distribution of PFGE patterns did not differ for MR and MS MRSA CONCLUSIONS: Use of mupirocin ointment in a program aimed at managing endemic MRSA infection or colonization resulted in a significant increase in the recovery of high-level MR MRSA isolates. These isolates appeared to emerge from our existing MRSA pool. A case-control study provided few clues concerning patients likely to harbor MR MRSA. We confirmed the position that the extended use of mupirocin ointment should be avoided in settings where MRSA is endemic.

Administration, Topical↗
PubMed1998

Blastomycosis in northeast Tennessee.

STUDY OBJECTIVES: To study the epidemiologic and clinical features of blastomycosis in northeast Tennessee. DESIGN: Retrospective review of blastomycosis cases in the region from 1980 through 1995. SETTING: Hospitals located in the Tri-Cities region of northeast Tennessee. PATIENTS: Seventy-two patients with confirmed blastomycosis infection. INTERVENTIONS: None. RESULTS: During the 1980 to 1995 study period, we documented 72 cases of blastomycosis. The mean age was 52 years (range, 13 to 86 years), most were male (69.4%), and nine were immunocompromised. A possible environmental exposure was noted for 28 patients. Pulmonary involvement represented the most common site of infection (61 cases), but multiorgan involvement was common (17 cases). Most patients with pulmonary blastomycosis (66%) presented with a chronic illness, and radiologic findings usually revealed local consolidation or a mass-like lesion. Nine patients developed ARDS with an associated mortality rate of 89%, compared with a 10% mortality for non-ARDS pulmonary cases. Antifungal treatment regimens varied widely, with amphotericin B often used for sicker patients. An epidemiologic evaluation revealed that the mean yearly incidence rate for blastomycosis quadrupled between 1980 and 1987 (0.31 cases/ 100,000 population) and 1988 to 1995 (1.23 cases/100,000 population) (p=0.00001). Most new blastomycosis cases in the 1988 to 1995 period occurred in three counties in the region where significant new construction projects have been underway. CONCLUSION: Blastomycosis is endemic in northeast Tennessee and the number of cases is increasing, coinciding with major new construction in the region. Clinicians in the area must be alert to this condition.

Adolescent↗
PubMed1997

Spinal epidural abscess associated with the use of temporary epidural catheters: report of two cases and review.

Spinal epidural abscess has rarely been associated with the use of epidural catheters. We describe two patients with epidural abscesses that occurred in relation to the use of temporary epidural catheters; a literature review yielded 20 additional well-described cases. The mean age of these 22 patients was 49.9 years, the median duration of epidural catheter use was 3 days, and the median time to onset of clinical symptoms after catheter placement was 5 days. The majority of patients (63.6%) had major neurological deficits, and 22.7% also had concomitant meningitis. Staphylococcus aureus was the predominant pathogen. Despite antibiotic therapy and drainage procedures, 38% of the patients continued to have neurological deficits. These unusual but serious complications of temporary epidural catheter use require efficient and accurate diagnostic evaluation, as they can be substantial.

Abscess↗
PubMed1997

Susceptibility of antibiotic-susceptible and antibiotic-resistant hospital bacteria to disinfectants.

OBJECTIVE: To evaluate whether hospital strains of antibiotic-resistant bacteria exhibited altered susceptibility to disinfectants. DESIGN: Antibiotic-susceptible bacteria were obtained from American Type Culture Collection: Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Klebsiella pneumoniae, Salmonella choleraesuis, and Pseudomonas aeruginosa. Hospital strains of antibiotic-resistant bacteria were obtained from clinical isolates, including: S aureus, S epidermidis, E coli, Enterococcus species, K pneumoniae, and P aeruginosa. The Association of Official Analytical Chemist's use-dilution method was used to test these 12 strains of 7 bacterial pathogens for their susceptibility to a phenol and a quaternary ammonium compound. For five pathogens, we tested a susceptible and a more resistant strain in 20 comparative trials (5 pathogens, 2 disinfectants, 2 dilutions per disinfectant). RESULTS: In our 20 comparative trials, the antibiotic-resistant strains exhibited an increased resistance to the disinfectant in only a single instance. CONCLUSIONS: Our data demonstrate that the development of antibiotic resistance does not appear to be correlated to increased resistance to disinfectants.

Bacteria↗
PubMed1994

Enterococcal meningitis: report of four cases and review.

Enterococci, a significant cause of human infections outside of the CNS, have only rarely been documented to cause meningitis. To add to our understanding of this uncommon infectious process, we report our experience with four patients with enterococcal meningitis and summarize findings associated with 28 additional cases found in the medical literature. The majority of the adult patients with this condition had coexistent chronic underlying illnesses and were frequently exposed to immunosuppressive therapy. In addition, more than one-third of these patients had experienced CNS trauma or surgery, and 31% had an infection with enterococci at a site other than the CNS. Pediatric patients predominantly had underlying CNS pathology primarily consisting of neural tube defects or hydrocephalus. Primary meningitis occurred in 25% of pediatric patients, with most of these episodes occurring in neonates. Most patients presented with expected signs, symptoms, and physical features of acute bacterial meningitis and had typical CSF abnormalities, including leukocytic pleocytosis, elevated protein levels, and hypoglycorrhachia. The overall mortality rate among patients with enterococcal meningitis was 13%. The small number of patients in this review failed to demonstrate a definite difference in mortality among patients treated with cell wall-active agents alone vs. those treated with combination therapy with an aminoglycoside, although studies of patients with other complicated enterococcal infections suggest that combination therapy would be preferable.

Aged↗
PubMed1990

Respiratory infections caused by Branhamella catarrhalis. Selected epidemiologic features.

PURPOSE: This work reviewed existing literature pertaining to the epidemiologic aspects of respiratory tract infections caused by Branhamella catarrhalis, examined certain epidemiologic features of B. catarrhalis infections occurring at this facility, and identified relevant areas in need of further study. PATIENTS AND METHODS: Literature dealing with the epidemiology of B. catarrhalis infections was reviewed. Records in this Veterans Administration hospital microbiology laboratory were reviewed and all B. catarrhalis isolates and pure cultures of Hemophilus influenzae and Streptococcus pneumoniae were noted for the January 1986 to June 1989 study period. RESULTS: B. catarrhalis is now recognized as a disease-causing pathogen that is particularly noted for its association with acute otitis media in children and lower respiratory tract infections in adults with underlying cardiopulmonary disease. It was recovered from 2.7 percent of all respiratory specimens submitted over a 42-month period at this Veterans hospital. When compared with H. influenzae and S. pneumoniae, B. catarrhalis was found to be the second most commonly isolated respiratory pathogen. It was frequently found in pure culture (53 percent) or in combination with H. influenzae, gram-negative bacilli, or S. pneumoniae. The seasonal recovery of B. catarrhalis was apparent for the November to May period compared with the June to October period (p less than 0.001). CONCLUSION: B. catarrhalis has emerged as a major respiratory pathogen in pediatric and adult patient populations. There is a distinct seasonal pattern associated with its recovery and reasons for this are unclear. Prevalence studies aimed at identifying colonization rates among "low" and "high" risk groups are needed. The availability of restriction endonuclease analysis as a typing system for B. catarrhalis should favorably impact upon future epidemiologic studies. Many B. catarrhalis isolates produce beta-lactamase, and therapeutic options must reflect this.

Adult↗
PubMed1989

Epidemiology of tuberculosis in North Carolina, 1966 to 1986: analysis of demographic features, geographic variation, AIDS, migrant workers, and site of infection.

We analyzed all cases of tuberculosis reported in North Carolina between 1966 and 1986, and related the incidence rate of tuberculosis (per 100,000 population) to age (0 to 4 years, 7.59; 5 to 14 years, 3.44; 15 to 24 years, 6.30; 25 to 44 years, 15.92; 45 to 64 years, 33.85; greater than 65 years, 51.54), race (white 9.03, nonwhite 47.40), and gender (male 25.49, female 11.25). Over the 21-year study period the annual number of cases declined from 1,248 to 711 (43%), and the incidence rate from 25.56 to 11.25 (56%). Although the incidence rate of tuberculosis fell for all subgroups, nonwhites continued to have an incidence rate 3.2 to 22.5 times higher than whites, depending on age. The standardized morbidity ratio (SMR) (by age, race, and gender) of tuberculosis in the eastern region of North Carolina was nearly twice that of the western region and unexplainable by its demographics. Between 1983 and 1986 only a small percentage of cases of tuberculosis in North Carolina were accounted for by migrant farm workers (1.7% to 2.7%) and patients with the acquired immunodeficiency syndrome (less than 1%). Tuberculosis is increasingly a disease of the elderly, especially nonwhite men. Tuberculosis is a geographically and demographically focal disease in North Carolina, and preventive strategies should be appropriately targeted.

Acquired Immunodeficiency Syndrome↗
PubMed1989

In vitro activity of cefpodoxime proxetil (U-76,252; CS-807) against clinical isolates of Branhamella catarrhalis.

Cefpodoxime proxetil (U-76,252; CS-807) is a new esterified oral cephem antibiotic with a broad antibacterial spectrum. Since data regarding the activity of cefpodoxime against Branhamella catarrhalis are limited, we tested its activity against 200 B. catarrhalis isolates. The drug was highly active against beta-lactamase-negative and -positive isolates; 99% of all strains tested showed a cefpodoxime proxetil MIC of less than or equal to 2.0 micrograms/ml.

Anti-Bacterial Agents↗
PubMed1988

An outbreak of Pseudomonas cepacia bacteremia associated with a contaminated intra-aortic balloon pump.

In January 1983, symptomatic Pseudomonas cepacia bacteremia developed in two patients in the cardiothoracic intensive care unit within 3 days after cardiac operation and insertion of an intra-aortic balloon pump. An epidemiologic and microbiologic investigation revealed that both patients required intra-aortic balloon pumping for circulatory support and that the water reservoir of the intra-aortic balloon pump (SMEC, Inc., Cookeville, Tenn.) contained more than 10(5) Pseudomonas cepacia per milliliter. This organism was also recovered from the purge button and on-off switch of the pump and from the hands of a health care worker who manipulated the water reservoir of the intra-aortic balloon pump. Agarose gel electrophoresis of lysates of Pseudomonas cepacia with rapid methods of deoxyribonucleic acid preparation revealed three identical plasmids of the Pseudomonas cepacia from the water reservoir of the intra-aortic balloon pump and from the infected patients. Transmission from the worker's hands to patients presumably occurred by inoculation of the intravascular lines during management. No additional cases of Pseudomonas cepacia bacteremia were observed after the unit was replaced with a nonwater reservior intra-aortic balloon pump. This report substantiates the ability of Pseudomonas cepacia to multiply in water and to cause epidemic bacteremia, identifies the water reservoir of the SMEC intra-aortic balloon pump as a previously unrecognized hazard for the patient requiring intra-aortic balloon pumping, and documents the value of plasmid analysis in elucidating the mode of transmission of nosocomial Pseudomonas cepacia infections.

Aged↗
PubMed1986

Factors associated with nephrotoxicity and clinical outcome in patients receiving amikacin.

Data from 60 patients treated with amikacin were analyzed for factors associated with nephrotoxicity. In 42 of these patients, data were examined for factors associated with clinical outcome. Variables evaluated included patient weight, age, sex, serum creatinine level, creatinine clearance, duration of therapy, total dose, mean daily dose, organism minimum inhibitory concentration (MIC), mean peak levels, mean trough levels, mean area under the serum concentration-time curve (AUC), total AUC, mean AUC greater than MIC, total AUC greater than MIC, mean Schumacher's intensity factor (IF), total IF, In (mean maximum concentration [Cmax]/MIC). Model-dependent pharmacokinetic parameters were calculated by computer based on a one-compartment model. When the parameters were examined individually, duration of therapy and total AUC correlated significantly (P less than .05) with nephrotoxicity. In contrast, a stepwise discriminant function analysis identified only duration of therapy (P less than .001) as an important factor. Based on this model and on Bayes' theorem, the predictive accuracy of identifying "nephrotoxic" patients increased from 0.17 to 0.39. When examined individually, mean IF, MIC, total dose, mean daily dose, and ln (mean Cmax/MIC) correlated significantly (P less than .05) with cure. In contrast, a simultaneous multivariable analysis identified IF, MIC, and total dose according to one model and ln (mean Cmax/MIC) according to a second statistical model of parameters selected to have the greatest prospective value. Based on Bayes' theorem and the first model, the predictive accuracy of identifying patients not cured increased from 0.19 to 0.83. For the second model, the predictive accuracy increased from 0.19 to 0.50.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Serious postoperative infections caused by coagulase-negative staphylococci: an epidemiological and clinical study.

We have reviewed all 3577 nosocomial infections occurring at our institution over a 49-month period and found coagulase-negative staphylococci (CNS) associated with 297. Seventy-eight of 193 CNS tested for antibiotic sensitivity were multiple-drug resistant (MR-CNS). There were 19 well-documented serious postoperative CNS infections including nine ventricular, seven bloodstream and three peritoneal infections. Each was associated with an indwelling device and 11 of the infections involved MR-CNS. Antibiotic therapy with or without removal of the device resulted in cure of all patients. Air samples taken during various surgical procedures frequently were positive for CNS but rarely revealed MR-CNS. Our results cause concern regarding current antibiotic prophylaxis regimens.

Air Microbiology↗
PubMed1985

Infection control programs in twelve North Carolina extended care facilities.

To assess the scope of infection control programs in extended care facilities, 1-day surveys were conducted in 12 North Carolina facilities over an 8-month period using a standardized questionnaire. All 12 facilities had a designated infection control practitioner (ICP), although none had attended an infection control education course. Eleven had an Infection Control Committee of which 8 (73%) met regularly. The Director of Nurses generally (58%) was the ICP and spent about 2 hr/wk on infection control. Ten (83%) facilities conducted infection surveillance among residents but did not accurately compute nosocomial infection rates. Eleven (92%) facilities had employee health programs that included preemployment and annual tuberculosis screening. None had a comprehensive resident health program. Infection control aspects of patient care practices often varied from facility to facility. Nosocomial infection surveillance among 336 residents in 9 facilities using modified CDC criteria revealed an overall prevalence rate of 5.4%. Additional infections were suspected but not included because of limitations of laboratory data and chart documentation.

Cross Infection↗
PubMed1984

A pocket calculator program for pharmacokinetic dosing of drugs exhibiting single compartment first-order elimination and zero-order or first-order absorption.

A pocket computer program has been designed to assist clinicians in the appropriate administration of most drugs exhibiting single compartment first-order elimination and either zero-order (intravenous infusions) or first-order (intramuscular and oral) absorption. The program utilizes well-established pharmacokinetic parameters to calculate an optimal drug dose and dosing interval based upon a patient's demographic characteristics and the drug half-life, volume of distribution, and absorption rate constant or infusion time. It also allows the user to estimate peak and trough drug serum concentrations. When measured serum concentrations are available during steady state, it is possible to determine individual patient drug half-life and volume of distribution for more accurate adjustments in dose and/or dosing interval. Usage of this program should enable clinicians to better select effective but safe drug dosing regimens based on individual patient needs and characteristics.

Absorption↗
PubMed1984

A potential infection hazard associated with the use of disposable saline vials.

Nosocomial respiratory tract infections have occasionally been associated with contaminated respiratory therapy devices and techniques. In the past two years, our hospital purchased disposable saline squeeze vials for use during suctioning of intubated patients. These vials have a cap which must be flipped or twisted-off by the user before the contents can be instilled into the patient's respiratory tract. We observed use of this item in our intensive care units (ICU) and studied the potential for contamination. ICU nurses use ungloved hand(s) to flip or twist-off squeeze vial cups resulting in skin contact with the vial opening. Cultures of nurses' hands and squeeze vial contents were obtained in the ICU where 24 nurses opened 92 vials in the manner previously described. Twenty-three percent of vial contents were contaminated and cultures revealed S. epidermidis, S. aureus, Streptococcus viridans and enterococcus. On six occasions, organisms recovered from vial contents were believed to be identical to organisms isolated from the hands of the nurse who opened the vial. When nurses used care in removing the saline vial cap, cultures of vial contents were sterile.

Bacterial Infections↗