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Biomedical subjects

G L Gilbert

Publications and source records attributed to G L Gilbert.

At least 109 records · Page 6Linked to original sources
PubMed1992

Antimicrobial susceptibility of anaerobic bacteria in Australia.

The susceptibilities of 900 clinical isolates of anaerobic bacteria to 14 antimicrobial agents were determined by an agar dilution technique. Chloramphenicol, imipenem and metronidazole were found to be active against virtually all of the strains; only a single Bacteroides fragilis isolate was resistant to both imipenem and metronidazole. The addition of clavulanic acid to amoxycillin and ticarcillin potentiated the activities of these agents against all anaerobes including members of the B. fragilis group. Ampicillin/sulbactam and clindamycin were the next most active agents, 91 and 89% of isolates respectively being susceptible. Seventy-three per cent of the bacteria tested were susceptible to cefoxitin and 65% to cefotetan, with the MICs of almost 50% of the isolates clustering between 16 and 32 mg/L. There was also clustering around the breakpoint (64 mg/L) of piperacillin. Azithromycin exhibited poor activity against the B. fragilis group; only 18% of isolates were susceptible to < or = 4 mg/L. However, 92% of non-B. fragilis Bacteroides group strains were susceptible to this agent. We conclude that imipenem, metronidazole, chloramphenicol, ticarcillin/clavulanate, co-amoxiclav and, to a lesser extent, ampicillin/sulbactam are suitable as empirical therapy for infections caused by anaerobic bacteria.

Anti-Bacterial Agents↗
PubMed1992

Outer membrane protein subtypes of Haemophilus influenzae type b isolates causing invasive disease in Victoria, Australia, from 1988 to 1990.

Outer membrane protein subtyping of 187 isolates of Haemophilus influenzae type b (Hib), isolated from children with invasive Hib disease in Victoria, Australia, showed that a single outer membrane protein subtype (1VA) was responsible for 83% of the infections. It was identical to that responsible for the majority of cases of invasive Hib disease in Europe.

Bacterial Outer Membrane Proteins↗
PubMed1991

Rifampicin prophylaxis for throat carriage of Haemophilus influenzae type b in patients with invasive disease and their contacts.

OBJECTIVE: To determine rates of colonisation with Haemophilus influenzae type b among household contacts of children with invasive H influenzae type b disease; compliance among medical staff with recommendations for use of rifampicin prophylaxis; and effects of rifampicin treatment in H influenzae type b colonisation of patients and contacts. DESIGN: Prospective study of patients and their household contacts. SETTING: Royal Children's Hospital (the major paediatric hospital) in Victoria, Australia, with catchment population of 4.2 million, including 300,000 children aged under 5 years. SUBJECTS: 234 patients (age range 6 weeks to 8 years) with 235 episodes of all types of invasive H influenzae type b disease admitted during 1988-9 and their contacts. MAIN OUTCOME MEASURES: Positive cultures of H influenzae type b from throat swabs taken at admission and six weeks subsequently; recording of rifampicin prophylaxis. RESULTS: The percentage of patients with positive throat cultures fell from 69% (33/48) on day 1 of admission to 9% (4/47) after three days' treatment; at six weeks' follow up 32% (32/99) of patients who had not received rifampicin and 8% (5/61) who had, had positive throat cultures. Among household contacts, 33% (62/190) of children and 7% (25/359) of adults were colonised, and the colonisation rates were similar in contacts of patients with all types of H influenzae type b disease. Rifampicin prophylaxis was indicated in 85 families; in 34% it was not prescribed at all for contacts and in 41% not as recommended. The colonisation rates at follow up were significantly less in siblings given rifampicin (12%, 9/78), particularly in families in which all members were treated (3%), than in those in which they were not (36%) (odds ratio 21.5; 95% confidence interval 3.0 to 103.4). CONCLUSIONS: The rate of throat colonisation with H influenzae type b was similar among siblings of children with all types of invasive H influenzae type b disease. Colonisation in contacts can be reduced by rifampicin prophylaxis, but some contacts remained colonised or were recolonised by the time of follow up. Medical staff complied poorly with current recommendations for rifampicin prophylaxis, which reduces its intrinsically limited value in preventing H influenzae type b disease.

Child↗
PubMed1991

Epidemiology of Haemophilus influenzae type b disease in Australia and New Zealand.

The epidemiology of infection due to Haemophilus influenzae type b (Hib) varies in different groups of Australian and New Zealand children. In most populations the annual case attack rate is approximately 40-60 per 100,000 children under 5 years of age and epiglottitis accounts for a relatively high but variable proportion of cases, which partly depends on case definition. Overall, nearly 50% of cases occur in children over 2 years of age. Among Aboriginal children in the Northern Territory, the epidemiology is strikingly different. The annual case attack rate is approximately 450 per 100,000 children under 5 years and varies in different geographical areas. Most cases occur in the first year of life (40% at less than 6 months) and epiglottitis is rare. The case attack rate in non-Aboriginal children in the Northern Territory (88 per 100,000) is significantly less than in Aboriginal children but higher than elsewhere. The differences between Maori and Caucasian children in New Zealand are less marked. Different immunization strategies may be required for children in different populations within Australia and New Zealand.

Child, Preschool↗
PubMed1991

Kingella kingae endophthalmitis in an infant.

An 11-month-old girl presented with metastatic endophthalmitis. The causative organism was the Gram-negative coccobacillus Kingella kingae. This is an uncommon organism first recognised in 1967. It has never been previously reported to cause endophthalmitis, but is associated with at least four other infective syndromes in children. Endophthalmitis is a potentially lethal and sight-threatening disease. Kingella kingae is primarily a paediatric pathogen which fortunately responds well to antibiotics. A case study, details of the bacteriology and a table of other clinical syndromes associated with this organism seen at our institution constitute this article. (12 references).

Anti-Bacterial Agents↗
PubMed1990

Haemophilus influenzae type b infections in Victoria, Australia, 1985 to 1987.

Invasive Haemophilus influenzae type b (HIB) infections occurring from 1985 to 1987 in children younger than 16 years of age living in the state of Victoria were reviewed. There were 547 cases which fulfilled the case definition, including 231 cases of meningitis, 219 of epiglottitis and 97 other infections; 14 (2.6%) children died, 8 with meningitis, 5 with epiglottitis and 1 with pneumonia. Ninety-five percent of cases occurred in children younger than 5 years of age, in whom the case attack rate was 58.5/100,000/annum. Nearly two-thirds of cases (46% of meningitis; 91% of epiglottitis; 45% of other infections) occurred in children more than 18 months of age (the age at which vaccine is presently given in the United States). Compared with the United States, the case attack rate for HIB disease in Victoria is lower, the mean age of affected children higher and the proportion with epiglottitis is greater. However, the incidence, age distribution and clinical manifestations of HIB disease in Victoria are similar to those described in Scandinavia before the successful introduction of vaccines. Effective conjugate vaccines against HIB disease are now available and the majority of cases are preventable (depending on the immunization schedule used). These data suggest that immunization of Victorian children against HIB infection should be cost-effective.

Adolescent↗
PubMed1990

Neonatal gram negative meningitis: a 10-year review, with reference to outcome and relapse of infection.

Twenty-four infants treated for neonatal Gram negative bacillary meningitis over a 10-year period were reviewed to determine the mortality and incidence of complications including relapse. Nine (37.5%) infants died; two survivors had major and 13 minimal or no handicap. Five (21%) infants had a relapse of meningitis after the initial course of treatment; two of these infants had been treated with cefotaxime. The outcome did not correlate with age, sex, gestation, cerebrospinal fluid (CSF) parameters or peripheral neutrophil counts. A poor outcome was associated with thrombocytopenia, persistence of viable organisms in the CSF for more than 24 h and with seizures, particularly in infants aged 7 days or less. There were no clinical or laboratory parameters predictive of subsequent relapse and there was no apparent relationship with choice or dose of antibiotic used or duration of treatment.

Cefotaxime↗
PubMed1989

Prevention of transfusion-acquired cytomegalovirus infection in infants by blood filtration to remove leucocytes. Neonatal Cytomegalovirus Infection Study Group.

A multicentre, controlled trial was carried out to determine whether removal of leucocytes from blood by means of 'Imugard IG500' (Terumo) filters would prevent transfusion-acquired cytomegalovirus (CMV) infection in newborn infants. 72 infants whose mothers were seronegative and who received some seropositive blood were followed for 6 months for evidence of CMV infection. There were no significant differences between the groups who received filtered and unfiltered blood in median gestation, birthweight, or amount of seropositive blood received (median volume 32.5 ml and 34.5 ml, respectively). 9 (21%) of the 42 infants who received unfiltered blood and none of the 30 who received filtered blood were infected with CMV. All infected infants weighed less than 1500 g at birth; they represented 31% of very low birthweight (VLBW) infants at risk of CMV infection. None of 24 VLBW infants who received filtered seropositive blood was infected. 1 infected infant died and 5 had clinical features consistent with CMV infection. The results show that transfusion-acquired CMV infection is preventable by filtration of blood through a leucocyte filter. This method has advantages over other methods of removing leucocytes or the use of only seronegative blood for newborn infants.

Antibodies, Viral↗
PubMed1989

Childhood tuberculosis in Victoria, 1970-86.

With the declining incidence of tuberculosis, childhood tuberculosis has become an uncommon disease in Australia. This study examines tends in childhood tuberculosis in the state of Victoria, Australia, over the period 1970-86. There was a decline in the incidence of pulmonary disease from 2.76 cases per 100,000 population in the period 1970-76 to 1.97 in the period 1980-86 (P less than 0.005). Non-pulmonary tuberculosis continued at a constant rate throughout the 17 year period. During the period of the study, 381 cases of pulmonary tuberculosis and 79 cases of non-pulmonary tuberculosis (most of which affected lymph nodes) were encountered in a total of 460 cases. Of these, 84 (18%) cases occurred in Indo-Chinese refugees.

Adolescent↗
PubMed1988

Outbreak of enterovirus 71 infection in Victoria, Australia, with a high incidence of neurologic involvement.

An outbreak of infections caused by enterovirus 71 occurred in southeastern Australia during the winter of 1986. Infection was confirmed by virus isolation or serology in 114 patients, 65 of whom were admitted to hospital. Fifty-one percent of inpatients were infants younger than 12 months old and 85% were younger than 5 years old. Many cases of hand, foot and mouth disease occurred in the community during the epidemic, but 51% (33 of 65) of patients admitted to hospital had central nervous system involvement, often associated with severe symptoms. Six patients had encephalitis and one had a poliomyelitis-like paralytic illness. Various skin manifestations other than hand, foot and mouth disease occurred, especially in young children, and 25 patients had significant respiratory disease including at least 7 with pneumonia. Enterovirus 71 is one of very few viruses that cause hand, foot and mouth disease as well as a variety of other clinical manifestations. The most important of these is meningoencephalitis, which causes significant morbidity, especially in infants and young children.

Child↗