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Biomedical subjects

F Schlaeffer

Publications and source records attributed to F Schlaeffer.

At least 37 records · Page 2Linked to original sources
PubMed2000

Hospital-acquired brevundimonas vesicularis septicaemia following open-heart surgery: case report and literature review.

Brevundimonas vesicularis (B. vesicularis) is a pseudomonad rarely encountered in human infection. A case of nosocomial septicaemia with this organism following open-heart surgery is presented, with a review of the literature. The isolate demonstrated resistance to ciprofloxacin and aztreonam, which has not yet been reported. Treatment with piperacillin/tazobactam resulted in full recovery. A review of the literature reveals that B. vesicularis is a virulent organism involved in serious infections such as central nervous system infection or bacteraemia, some of which are nosocomial. Meanwhile, empiric therapy for B. vesicularis infection should include a broad-spectrum antimicrobial agent until susceptibility results are known.

Adult↗
PubMed2000

Epidemiology and ethnic distribution of multidrug-resistant tuberculosis in southern Israel, 1992-1997: the impact of immigration.

STUDY OBJECTIVES: To assess the incidence of tuberculosis in the native and immigrant populations of southern Israel in the period between 1992 and 1997, and to study the prevalence of drug resistance overall and among these subpopulations in the region in order to create guidelines for empirical antituberculous treatment in this region. DESIGN: A retrospective population-based study. SETTING: The southern district of the country and its tertiary-care hospital. PATIENTS: All new culture-proven tuberculosis cases diagnosed in adults residing in the Negev region during the study period. Patients were classified into four groups according to ethnic origin and immigration date. RESULTS: During the study period, 249 new cases involving 249 patients were recorded. Immigrants from the former Soviet Union (IFSU) were significantly younger and of male gender, and the incidence among this group rose sharply. IFSU had higher rates of resistance to any drug or drug combination. Isoniazid resistance rates were 16% overall and 32% among IFSU. Resistance to any drug was observed in 29% overall and 50% of isolates among IFSU. Multidrug-resistant tuberculosis was observed in 8.5% and 17%, respectively. CONCLUSIONS: The population of southern Israel carries very high rates of drug-resistant tuberculosis, mandating quadruple empiric treatment. IFSU should be regarded as having multidrug-resistant tuberculosis until proven otherwise, and empiric therapy with at least five drugs should be considered. This report demonstrates the influence of immigration on the incidence of tuberculosis, and the great value of local surveillance of population-specific resistance rates in an immigrant society, in order to optimize drug treatment and prevent the dissemination of resistant strains.

Adult↗
PubMed1999

Granulocyte-colony stimulating factor for the prevention of chemotherapy-induced febrile neutropenia in the adult cancer patient population of Southern Israel.

To evaluate the efficacy of granulocyte-colony stimulating factor (G-CSF) prophylaxis in preventing chemotherapy-induced febrile neutropenia in the heterogeneous population of adult cancer patients treated in our institution, all adult cancer patients with either a solid tumor or lymphoma who were admitted for chemotherapy in our institution between 1 January 1994 and 31 July 1995 were retrospectively studied. We compared the characteristics of chemotherapy cycles in which G-CSF was given as prophylaxis and of those with no prophylaxis. In all, 1,079 chemotherapy cycles given to 209 patients were analyzed. Prophylaxis with G-CSF was given in 66 cycles (6%). Patients receiving G-CSF were significantly younger and were more likely to have lymphomas. Febrile neutropenia developed in 40 cycles (4%). There was no difference in the rates of febrile neutropenia, infection, hospitalization or mortality between the study groups in general, and cycles administered to patients being treated for lymphomas in particular. The routine use of prophylactic G-CSF in a mixed cancer patient population with a low incidence of febrile neutropenia is not justified and should be reserved for individual patients with a high likelihood of developing febrile neutropenia.

Adolescent↗
PubMed1999

Infective endocarditis due to Fusobacterium nucleatum in an intravenous drug abuser.

Infective endocarditis due to anaerobic non-spore-forming gram-negative bacilli in intravenous drug abusers is exceedingly rare, with only two cases being previously reported in the literature. A case of endocarditis due to Fusobacterium nucleatum in an intravenous drug abuser is reported, accompanied by a review of the literature.

Adult↗
PubMed1999

Clinical features and costs of care for hospitalized adults with primary Epstein-Barr virus infection.

PURPOSE: To study the clinical and laboratory features of primary infection with the Epstein-Barr virus in adults who required hospitalization and to assess the difficulty in its diagnosis, the use of diagnostic procedures, and the associated costs of care. PATIENTS AND METHODS: We retrospectively identified all adult patients who were diagnosed with primary Epstein-Barr virus infection in our region between 1988 and 1997 using strict serologic criteria. The added costs of unnecessary diagnostic tests and treatment were estimated. RESULTS: The analysis included 47 patients (60% men) with a mean (+/-SD) age of 30 +/- 14 years. The prime cause of admission was fever (83%). Compared with patients 35 years of age and older, those younger than 35 years were more likely to have pharyngitis (45% vs 10%) and lymphadenopathy (66% vs 17%). Younger patients also had a greater mean atypical lymphocyte count (17% +/- 14% vs 8% +/- 6%) and more abnormal hepatic enzyme levels. Inpatient work-ups resulted in 309 days of hospitalization, many diagnostic tests, and unnecessary empiric treatments (total 203 days of antibiotic therapy). Overall, unnecessary diagnostic procedures and medical treatments contributed an average of approximately $12,000 in health-care costs per patient. CONCLUSIONS: Testing for primary Epstein-Barr virus infection should be a routine step in the investigation of fever in adults of all ages. A higher index of suspicion might prevent unnecessary, sometimes hazardous inpatient work-ups from being performed, thereby reducing health-care expenses.

Adult↗
PubMed1999

Fatal Clostridium sordellii ischio-rectal abscess with septicaemia complicating ultrasound-guided transrectal prostate biopsy.

Clostridium sordellii is a Gram-positive spore-forming anaerobic bacillus rarely encountered in human infection. A case of C. sordellii ischio-rectal abscess with rapidly fatal septicaemia is described which complicated ultrasound-guided transrectal biopsy of the prostate, despite ciprofloxacin prophylaxis. Neither C. sordellii ischio-rectal abscess nor ischio-rectal abscess complicating transrectal biopsy have been reported previously. Judging from our experience and the reviewed literature, the addition of prophylactic anti-anaerobe drugs should be strongly considered until an optimal prophylactic regimen will be defined by randomized controlled trials.

Abscess↗
PubMed1998

Enterococcus hirae septicemia in a patient with end-stage renal disease undergoing hemodialysis.

Enterococcus hirae, member of the Enterococcus genus known to cause infection in animals, is rarely encountered in clinical practice. There are no published reports describing clinical features of Enterococcus hirae infection in humans. A case of Enterococcus hirae septicemia in a 49-year-old patient with end-stage renal disease undergoing hemodialysis is reported here. A review of the available literature regarding the clinical spectrum of Enterococcus hirae infection in humans and the antimicrobial susceptibility of Enterococcus hirae is also included.

Bacterial Infections↗
PubMed1998

Fatal necrotizing fasciitis caused by a toothpick injury.

Necrotizing fasciitis is a severe life-threatening infection. The portal of entry is usually a site of disruption of the skin barrier. We report a case of fatal necrotizing fasciitis caused by an accidental toothpick injury--a unique injury mechanism not reported this far to cause necrotizing fasciitis. Although toothpick injuries are usually regarded as trivial, it should be kept in mind that they have the potential to cause such a lethal infection.

Abscess↗
PubMed1998

Imported severe falciparum malaria in Israel.

Malaria remains an overwhelming problem in tropical developing countries, with 300 to 500 million new cases and 1.5 to 3.5 million deaths per year. Malaria is a potentially life-threatening disease for travelers to the tropics. Imported malaria is an important clinical problem in nonendemic areas of the world because of increasing numbers of travelers, overseas workers, and immigrants from endemic areas. According to the World Health Organization's criteria, the recognition of one or more of the following clinical features should raise the suspicion of severe malaria: cerebral malaria (unrousable coma), severe anemia (hemoglobin <5 g/dL), renal failure (serum creatinine >3 mg/dL), pulmonary edema or adult respiratory distress syndrome, hypoglycemia (glucose <40 mg/dL), circulatory collapse or shock, disseminated intravascular coagulation, repeated generalized convulsions, acidosis (pH <7.25), macroscopic hemoglobinuria, hyperparasitemia (>5 percent of the erythrocytes infested by parasites), or jaundice (bilirubin >3 mg/dL). Although only a small proportion of patients with malaria develops severe manifestations, these patients require the most urgent and intensive care. Mortality among patients with cerebral malaria, even when treated in modern intensive care units, exceeds 30%, and when complicated by the adult respiratory distress syndrome, it may approach 80%. Among travelers, mortality remains a serious issue because of failure to obtain and use preventive measures, delay in seeking medical attention, and misdiagnosis.

Adult↗
PubMed1998

Prospective study to determine clinical relevance of detection of pneumococcal DNA in sera of children by PCR.

We undertook a prospective study to evaluate the accuracy of PCR of serum (aimed at the pneumococcal pneumolysin gene) at detecting pneumococcal infections in infants and children. The assay was positive for all blood and cerebrospinal fluid culture-positive samples and for 38 and 44% of patients with lobar pneumonia and acute otitis media, respectively. It was positive for 17% of healthy controls. There was a marked effect of age on the rate of positivity among healthy controls, with the highest rate (33%) being in 2-year-old children, the age group with the highest rate of nasopharyngeal (NP) carriage; the lowest rate was found among infants <2 months of age (13%) and adults ages 18 to 50 years (0%), age groups with the lowest NP pneumococcal carriage rates. Carriers of pneumococci in the nasopharynges had a higher rate of positivity than noncarriers of pneumococci in the nasopharynges for all groups. Our results suggest that although PCR of serum is a sensitive test for the detection of Streptococcus pneumoniae in sterile fluids, its high rate of positivity for healthy controls, related to NP pneumococcal carriage, might exclude it from being useful in detecting deep-seated pneumococcal infections.

Adolescent↗
PubMed1998

Infective endocarditis in a tertiary-care hospital in southern Israel.

During the years 1980-1994, 84 patients were treated in our institution due to suspected infective endocarditis (IE). Seventy-one of these episodes occurring in 71 patients, classified definite or possible according to the Duke criteria, were retrospectively analyzed in this study. There were 52 cases of native valve endocarditis, 7 cases of early prosthetic valve endocarditis, and 12 cases of late prosthetic valve endocarditis. The incidence of IE did not change significantly during the study period. The overall mortality rate was 15%. Only one case of drug addiction appeared in our series despite its growing frequency in Israel. Rheumatic heart disease remained the main underlying cardiac condition and Streptococcus viridans remained the most common pathogen. Streptococcus bovis was found to be a significant pathogen causing IE in our patient population, while Staphylococcus aureus appeared to be less frequent. The Duke criteria significantly classified a greater proportion of cases as definitive, as opposed to the von Reyn criteria. Fewer cases were rejected by the Duke criteria, especially culture-negative cases, and those without histopathological confirmation. Application of the Duke criteria permits a more consistent approach to the diagnosis of IE, even in a non-drug-addict patient population.

Adolescent↗
PubMed1997

Changing trends in frequency and antimicrobial resistance of urinary pathogens in outpatient clinics and a hospital in Southern Israel, 1991-1995.

In order to monitor changes in the frequency and antimicrobial resistance of urinary pathogens over several years, urinary cultures received from outpatient clinics and from a hospital during a period of one month each in 1991 and 1995 were analyzed at a clinical microbiology laboratory. In 1991 and 1995, 1366 and 1534 significant monomicrobic cultures respectively were reviewed. The frequency of Escherichia coli dropped significantly in the outpatient clinics from 70.5% to 61.2% (p < 0.0001). The frequency of Proteus mirabilis, Morganella morganii, Pseudomonas aeruginosa and other gram-negative bacteria also decreased, but the frequency of Klebsiella spp. and Enterobacter spp. increased from 2.6% to 5.8% (p < 0.0001). In the hospital, the frequency of Enterobacter spp. (p < 0.04), Escherichia coli and Morganella morganii declined from 1991 to 1995, whereas the frequency of Pseudomonas aeruginosa (p = 0.001), Acinetobacter spp. (p < 0.05), Klebsiella spp., Proteus mirabilis and other gram-negative rods increased considerably. The frequency of gram-positive aerobic bacteria rose markedly in outpatient specimens from 6.1% to 13.5% (p < 0.0001), while a decline from 14.4% to 9.3% was noted in hospital specimens (p < 0.02). A significant rise in the resistance of Escherichia coli to gentamicin and ciprofloxacin (p < 0.0001) was detected in outpatient isolates. In the hospital, gram-negative urinary pathogens demonstrated increased resistance to ampicillin (p = 0.042), cefuroxime (p = 0.005), gentamicin (p = 0.002) and ciprofloxacin (p < 0.0001) during the study period. The changing etiology of urinary tract infections and the increasing resistance of organisms indicate that periodic monitoring and possibly also modification of empirical therapy are required.

Ambulatory Care Facilities↗
PubMed1997

Pneumococcal community-acquired pneumonia in 148 hospitalized adult patients.

In a previous prospective study, Streptococcus pneumoniae was identified as the causative agent in 148 (42.8%) of 346 adult patients hospitalized over the course of one year with community-acquired pneumonia (CAP) in the Soroka Medical Center, Beer-Sheva, Israel. The present study characterizes those cases in which Streptococcus pneumoniae was the only pathogen and those in which additional etiological agents were identified. Pneumococcal CAP was diagnosed by standard blood cultures or positive serological tests by one of two laboratory methods. In 100 (67.6%) patients, at least one other etiological agent of CAP was identified in addition to Streptococcus pneumoniae. Compared with patients who were not infected by Streptococcus pneumoniae, patients with Streptococcus pneumoniae CAP were older and had a higher rate of comorbidity (39.5% vs. 29.8%). Streptococcus pneumoniae CAP had a more severe clinical course and a higher mortality rate, especially when Streptococcus pneumoniae was the only pathogen. Community-acquired pneumonia due to Streptococcus pneumoniae only was more similar in its clinical manifestations to classic typical pneumococcal pneumonia. When an additional etiological agent was identified, the clinical characteristics could not be distinguished from those of atypical pneumonia. It is concluded that Streptococcus pneumoniae remains the principal cause of CAP in this region. The frequency of additional etiological agents of CAP and the difficulty in differentiating clinically between cases due to Streptococcus pneumoniae only and those due to Streptococcus pneumoniae plus other organisms necessitates initial empirical treatment that covers Streptococcus pneumoniae as well as other causative agents of atypical pneumonia.

APACHE↗
PubMed1997

Septic arthritis due to bacteroides fragilis after pilonidal sinus resection in a patient with rheumatoid arthritis.

Bacteroides fragilis is a rare cause of septic arthritis. Most patients with B. fragilis septic arthritis have a chronic joint disease, particularly rheumatoid arthritis, and sources of infection are lesions of the gastrointestinal tract and the skin. We report a 69-year-old male, who developed B. fragilis septic arthritis after pilonidal sinus resection. High level of suspicion of development B. fragilis septic arthritis must be present in patients with chronic joint disease in whom gastrointestinal or skin surgery was previously performed.

Aged↗
PubMed1997

The epidemiology of community-acquired pneumonia among hospitalized adults.

OBJECTIVE: To identify and characterize the aetiological agents of community-acquired pneumonia (CAP) among hospitalized patients, as an aid in therapeutic decision-making. METHOD: A prospective 1 year study of all patients hospitalized with CAP in the Negev region of Israel. The aetiology was determined by blood and pleural fluid cultures, and specific serological testing for pathogenic agents. Eighty-nine percent of the patients underwent follow-up for a month after discharge. RESULTS: The study included 346 patients (53% males, mean age 49.3 +/- 19.5, range 17-94). A single aetiologic agent was identified in 146 patients (42.2%), multiple agents were found in 133 (38.4%), and no agent was identified in 67 (19.4%). Among the common pathogens were Pneumococcus sp. in 148 patients (42.8%). Mycoplasma pneumoniae (101, 29.2%), Chlamydia pneumoniae (62, 17.9%), Legionella sp. (56, 16.2%), viruses (35, 10.1%), Coxiella burnetti (20, 5.8%). Haemophilus influenzae (19, 5.5%), and other bacteria (21, 6.1%). Approximately 70% of the patients infected with M. pneumoniae and C. burnetti were younger than 45 years (P < 0.05). In contrast, about 50% of the patients with C. pneumoniae (TWAR) were over the age of 65 (P = 0.03). The presence of comorbidity was associated with a greater frequency of bacterial aetiologies (57% vs. 44%, P = 0.02), and fewer infections with M. pneumoniae (15% vs. 36%, P = 0.0004), or C. burnetii (2% vs. 8%, P = 0.02). Specific causative agents were associated with specific seasons: viruses between December and April (P = 0.03), and Legionella sp. from July to October (P = 0.003). In contrast, no seasonal variation was associated with pneumococcus, M. pneumoniae, or C. pneumoniae (TWAR). CONCLUSIONS: Patients are hospitalized with CAP throughout the year. Since the pathogen is usually unknown at hospitalization, epidemiological data is important for choosing medication. The findings of this study point to the importance of macrolides alone or in combination with cephalosporins, as the treatment of choice for patients in our region.

Adolescent↗