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Biomedical subjects

I Brook

Publications and source records attributed to I Brook.

At least 361 records · Page 20Linked to original sources

Infectivity of organisms recovered from polymicrobial abscesses.

The ability to cause subcutaneous abscesses in mice was used to identify the pathogens among the bacteria recovered from 13 clinical abscesses. A total of 35 isolates (30 anaerobes and 5 aerobes), 16 of which were encapsulated, were recovered from these abscesses. Encapsulated organisms included eight Bacteroides spp. (three Bacteroides asaccharolyticus and one strain each of Bacteroides oralis, Bacteroides intermedius, Bacteroides biacutus, Bacteroides vulgatus, and Bacteroides ruminicola subsp. brevis), three anaerobic gram-positive cocci, two Clostridium spp., and two strains of Escherichia coli. Single organisms, or combinations thereof, obtained from these abscesses were inoculated subcutaneously into mice. All but one of the encapsulated organisms were able to cause abscesses by themselves and were recovered from the abscesses when inoculated with other organisms. Seven non-encapsulated organisms which were also recovered mixed with the encapsulated organisms were never able to cause abscesses nor could they be recovered after they were injected alone. Thirteen strains that did not induce abscesses when injected by themselves into mice survived when injected with other organisms which were encapsulated. In three instances, pairs of non-encapsulated organisms belonging to the last group were able to induce an abscess and survive in it when inoculated together. It was shown that the possession of a capsule by a clinical isolate increases the likelihood that it is a major contributor to the infectious process.

Abscess↗

In vitro protection of group A beta-hemolytic streptococci from penicillin and cephalothin by Bacteroides fragilis.

beta-Lactamase produced by Bacteroides fragilis could protect from antibiotics group A beta-hemolytic streptococci (GABHS), penicillin-susceptible pathogens frequently isolated from acute tonsillitis in children. To test this hypothesis we determined the minimal bactericidal concentration (MBC) to penicillin and cephalothin of GABHS alone and in mixed culture with eleven beta-lactamase-producing strains of B. fragilis. B. fragilis strains with MBC values less than or equal to 32 micrograms/ml to penicillin and less than or equal to 64 micrograms/ml to cephalothin did not provide any protection for GABHS. However, strains with MBC greater than or equal to 128 micrograms/ml to penicillin and greater than or equal to 256 micrograms/ml to cephalothin provided protection by increasing the MBC of GABHS at least 8,534 times for penicillin and 2,048 times for cephalothin. This phenomenon was most marked in 5% CO2. B. fragilis provided no protection against clindamycin. These results may explain the inability of penicillin therapy to completely eradicate GABHS from cases of recurrently infected tonsils.

Bacteroides fragilis↗

Treatment of anaerobic infections in children with metronidazole.

The tolerance and efficacy of metronidazole were studied in 15 pediatric patients who had anaerobic infection. 5 had soft tissue abscess, 4 had aspiration pneumonia, 3 had intracranial abscess and 3 had chronic sinusitis. 45 bacterial isolates were recovered (3 isolates per patient). 40 were anaerobes and included 17 Bacteroides sp. (8 sp.), 16 anaerobic cocci and 6 Fusobacterium nucleatum. Metronidazole was given intravenously at the dose of 30 mg/kd/day or orally in the dose of 40-50 mg/kg/day. The length of therapy was between 14 and 52 days (average 26 days). 7 of the patients received initial parenteral therapy for 5-21 days (average 11.6 days), and subsequently received oral therapy. The minimal inhibitory concentration of 38 of the 41 anaerobic isolates (93%) was equal or less than 2 micrograms/ml. The mean peak concentration of metronidazole on the third day of therapy was 24.2 micrograms/ml range 15.2-30 micrograms/ml) and the mean trough was 7.2 micrograms/ml (range 4-11.6 micrograms/ml). No local or systemic adverse reaction as noted. A good response to therapy with a complete cure occurred in 14 of the 15 children. A fair response was achieved in 1 patient. Metronidazole appears to be effective and safe in the treatment of serious anaerobic infection in children.

Adolescent↗

Antimicrobial drugs used in the management of anaerobic infections in children.

Optimum antimicrobial therapy effective against anaerobes is required to rapidly resolve infections due to these organisms and to prevent serious complications. Selection of antimicrobial therapy should be based on clinical experience and presumptive evidence until culture and sensitivity tests are available. If an abscess should develop, surgical drainage (when possible) is of paramount importance. Antimicrobial therapy for anaerobic infections should usually be given for prolonged periods because of the tendency for relapse, and should include coverage for aerobic bacteria whenever they are present. Penicillin G remains the drug of choice for most anaerobic infections except those caused by beta-lactamase-producing Bacteroides spp. such as B. fragilis and B. melaninogenicus, and some strains of Fusobacterium varium, which can be resistant. Other antimicrobials which are available for treatment of anaerobic infections in paediatric patients, and are generally active against B. fragilis, are carbenicillin, ticarcillin, chloramphenicol, clindamycin and cefoxitin. Experience in the use of metronidazole suggests that it could be a very valuable antimicrobial agent in the treatment of anaerobic infections. Experience with synergistic antimicrobial combinations in the treatment of anaerobic infections is limited; only experimental data are available suggesting synergism between penicillin and aminoglycosides against some Bacteroides spp. beta-Lactamase-producing anaerobic bacteria may protect other penicillin-susceptible bacteria in mixed infections. This phenomenon may explain penicillin failure in eradicating mixed infections.

Anti-Bacterial Agents↗

Distribution of beta haemolytic streptococci in pharyngitis specimens obtained from children.

One hundred and nine isolates of beta haemolytic streptococci were recovered from 840 (13%) pharyngeal cultures obtained from children with acute pharyngitis. Seventy-four percent of these were group A, 4% were group B, 9% were group C, 1% were group D, 4.5% were group F, and 5.5% were group G. The significance of non-group A isolates in pharyngitis could not be evaluated in the absence of viral and serological studies. However, these findings demonstrate the predominance of group A beta haemolytic streptococci in acute pharyngitis in children, as compared to findings in adults.

Adolescent↗

Transtracheal aspiration in pulmonary infection in children with cystic fibrosis.

Six transtracheal aspirations (TTA) and expectorated sputum specimens were collected from four children suffering from cystic fibrosis who had pulmonary infection. Specimens obtained from both sites were cultured for aerobic bacteria and TTA aspirates were also cultured for anaerobes. Differences in bacteria isolated in TTA and sputum aspirates were present in all instances. Six isolates were recovered in both sites (three Pseudomonas aeruginosa, two Staphylococcus aureus and one Aspergillus flavus). Five aerobic isolates were recovered only in the expectorated sputum and not in TTA aspirations (two Klebsiella pneumoniae and one each of P. aeruginosa, Escherichia coli and Proteus mirabilis). Nine organisms were isolated only from the TTA (two each of Veillonella parvula and Alpha hemolytic streptococci, and one each of Bacteroides fragilis, B. melaninogenicus, Lactobacillus sp., Haemophilus influenzae and Gamma hemolytic streptococci). The recovery of anaerobic organisms from four of the six TTA specimens suggests a possible role for these organisms in the etiology of pulmonary infection in cystic fibrosis. We found TTA to be helpful in the bacterial diagnosis and management of pulmonary infections in cystic fibrosis.

Adolescent↗

Stability of lactic acid in cerebrospinal fluid specimens.

The stability of lactic acid in cerebrospinal fluid specimens from children with or without infections of the central nervous system was determined. Twenty-six patients were studied. These were ten children with bacterial meningitis, nine with aseptic meningitis and seven without any inflammation of the central nervous system. The specimens were left at room temperature and lactic acid concentration was measured at sequential intervals: 15 minutes, and two, six and 24 hours following their collection. A decline in the concentration was noticed in all specimens. However, the most marked total reduction in lactic acid concentration was noted in specimens obtained from patients with bacterial meningitis. The average reduction in that group was 5 mg/dl after two hours, 11 mg/dl after six hours and 18 mg/dl following 24 hours. Lactic acid concentration remained unchanged up to 72 hours in specimens frozen at -20 degrees C. To prevent misleading results, it is recommended that cerebrospinal fluid specimens not be left at room temperature for prolonged periods of time prior to lactic acid determination.

Child↗

Effect of diving and diving hoods on the bacterial flora of the external ear canal and skin.

The bacterial flora of the external ear canals and posterior auricular skin surfaces were investigated in a group of 26 divers after 25 dry-suit dives in harbor water and 20 dry-suit dives in clear test tank test. A control group of 16 divers wore rubber hoods 19 times for a similar period (25 to 30 min) but did not dive. The protective effect of 2% acetic acid was tested by instilling it in the left ear of 14 divers and 8 nondivers. Staphylococcus epidermidis, Propionibacterium acnes, alpha-hemolytic streptococci, and enteric gram-negative rods were the predominant isolates from skin and ear samples. After the divers dove or after they wore hoods without going in the water, there was a substantial increase in the number of these organisms on the skin (46.9%) or in the external ears (43.8%) of the divers. However, an increase in the bacterial counts in the external ear canals occurred in only 13.6% of the individuals treated prophylactically with acetic acid drops. Although no gram-negative rods were recovered from the skin or external ear canals of divers in clear tank water, 23 strains were isolated after the dives in harbor water. Identical gram-negative isolates also were recovered from the harbor water. Gram-negative organisms also were recovered from three newly acquired skin lacerations, where they persisted for at least 24 h. Our data show the acquisition of gram-negative rods when dives were made in polluted water. The data also demonstrate the increase in bacterial counts that occurs when rubber diving rods are worn (in or out of water) and that this increase can be controlled by pretreatment of ears with acetic acid.

Acetates↗

Collection and transportation of specimens in anaerobic infections.

Management of anaerobic infection depends on appropriate documentation of the bacteria causing the infection. Proper collection of specimens in a manner that avoids contamination by normal flora and prompt delivery to the microbiology laboratory are of utmost importance. Materials appropriate for anaerobic culture include blood specimens, aspirates of body fluids (pleural, pericardial, cerebrospinal, peritoneal, and joint fluids), urine collected by suprapubic aspiration, abscess contents, deep wound aspirates, and specimens obtained by special procedures such as transtracheal aspiration or lung puncture. Unacceptable or inappropriate specimens can be expected to yield normal flora also and therefore have no diagnostic value. These include coughed sputum, throat swabs, feces, gastric aspirates, voided urine, and vaginal swabs. Aspirates of liquid specimen or tissue are always preferred to swabs, although systems for the collection of all culture forms are commercially available.

Anaerobiosis↗

Detection of bacteraemia in children seen in the outpatient department: a comparison of conventional blood culture methods and a Castaneda blood culture.

Modified Castaneda blood culture bottles were used to diagnose bacteraemia in children attending the out patient clinic. Bacterial growth was detected in twelve out of 147 patients (8%), in both the routine and Castaneda blood culture bottles. Streptococcus pneumoniae was recovered in nine patients (6%), and H. influenzae in three patients (2%). The average length of time required to identify the organisms utilizing the routine blood culture bottles was 2 days (range 1 to 4 days), while the average time utilizing Castaneda bottles was 3.5 days (range 1 to 6 days). Castaneda blood bottles were found in this work to be effective in the detection of bacteraemia in children, and because of their simplicity they may serve for the detection of bacteraemia by physicians in general practice.

Bacteria↗

Diagnosis of anaerobic infections in children.

Clinical and bacteriologic findings which suggest anaerobic infection include: situations predisposing to anaerobic infection, such as maternal amnionitis, bowel perforation or a human bite; presence of necrotic, gangrenous tissue; foul-smelling discharge or free gas; persistent or recurrent infection during the use of antibiotics effective only against aerobes, and the inability to grow organisms seen on gram stain when they are cultured aerobically. Almost all of these infections originate from the microflora of the neonate or child.

Anti-Bacterial Agents↗

Bacteriologic features of chronic sinusitis in children.

Aspiration of chronically inflamed sinuses was aseptically performed in 40 children. The median age was 11 years (range, 6 to 16 years). The sinuses were the maxillary (15 cases), ethmoid (13), and frontal (seven). Pansinusitis was present in five patients. All aspirates were cultured for aerobes and anaerobes and yielded bacterial growth in 37 patients. A total of 121 isolates (97 anaerobic and 24 aerobic) were recovered, accounting for 2.7 anaerobes and 0.6 aerobes per specimen. Anaerobic organisms were recovered from all 37 culture-positive specimens, and in 14 cases (38%) they were mixed with aerobic organisms. The predominant anaerobic organisms were Bacteroides species (36), anaerobic Gram-positive cocci (28), and Fusobacterium species (13). The predominant aerobic isolates were alpha-hemolytic streptococci (seven), Staphylococcus aureus (seven), and Haemophilus species (four). These findings indicate the major role of anaerobic organisms in the polymicrobial cause of long-term sinusitis in children.

Adolescent↗