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Biomedical subjects

I Gasser

Publications and source records attributed to I Gasser.

At least 37 records · Page 2Linked to original sources
PubMed1993

Incidence of listeriosis in Barcelona, Spain, in 1990. The Collaborative Study Group of Listeriosis of Barcelona.

A population-based register of cases of listeriosis admitted to acute-care hospitals has been established in Barcelona, Spain, in order to estimate the basal incidence of sporadic cases and to facilitate epidemiological surveillance of potential epidemics. Eleven acute-care hospitals reported all cases of listeriosis to a central unit following a standardized protocol. During 1990, 31 patients with listeriosis were identified, 18 of whom were residents of the city, resulting in an annual incidence of 10.95 cases per million inhabitants. Twelve of the 31 cases occurred in the period from July to September 1990, ten of them being community-acquired. The incidence of listeriosis was higher in elderly (> or = 65 years) and immunosuppressed persons. Forty-two percent of the cases were considered to be nosocomial infections. The overall mortality rate was 51.6%. The incidence of listeriosis in the present study is one of the highest reported in the literature. A high sensitivity of the reporting system with good case identification techniques, or demographic and environmental characteristics related to Listeria monocytogenes infection in our area, might be possible reasons for this geographic variation.

Adolescent↗
PubMed1993

Randomized trial comparing ceftriaxone with cefonicid for treatment of spontaneous bacterial peritonitis in cirrhotic patients.

We compared cefonicid (2 g every 12 h) and ceftriaxone (2 g every 24 h) for their efficacy and safety in treating spontaneous bacterial peritonitis in cirrhotic patients in an open randomized clinical trial (30 patients in each group). Clinical, laboratory, and bacteriologic characteristics were similar in both groups. Ceftriaxone-susceptible strains were isolated on 44 occasions (94%), and cefonicid-susceptible strains were isolated on 43 occasions (91.5%). The antibiotic concentration in ascitic fluid/MIC ratio for ceftriaxone was > 100 throughout the dose interval (24 h), while it was lower for cefonicid (between 1 and 18). A total of 100% of patients treated with ceftriaxone, and 94% of those treated with cefonicid were cured of their infections (P was not significant). Hospitalization mortality was 37% in the cefonicid group and 30% in the ceftriaxone group (P was not significant). The time that elapsed between the initiation of treatment and the patient's death was shorter in the cefonicid group patients (5.3 +/- 3.90 days) than in the ceftriaxone group patients (11.8 +/- 9.15 days) (P < 0.05). None of the patients presented with superinfections, and only two patients treated with cefonicid and three patients treated with ceftriaxone developed colonizations with Enterococcus faecalis or Candida albicans. Ceftriaxone and cefonicid are safe and useful agents for treating cirrhotic spontaneous bacterial peritonitis, although the pharmacokinetic characteristics of ceftriaxone seem to be more advantageous than those of cefonicid.

Aged↗
PubMed1993

[Bite wound infections: study of 22 hospitalized patients].

BACKGROUND: To study the characteristics of bite wounds with unfavorable evolution, developing infectious complications that requires hospital admission. METHODS: The data from 22 patients admitted to the Ciudad Sanitaria Vall d'Hebron hospital for the above mentioned reason over the last 5 years were reviewed. RESULTS: The patients (8 males, 8 females and 6 children) were bitten by 10 dogs, 6 cats, and 6 men with predominance of the wound site being in the upper limb (10) followed by the lower limbs (6), head or face (5) and exceptionally on the breast (1). The most frequent clinical manifestation was abscess and/or cellulitis (13) and adenopathies or lymphangitis (4); 5 patients presented osteoarticular involvement including 3 bone fractures due to human aggression. With regard to the etiology of infection, the common bucal flora bacteria were isolated in all the cases; Pasteurella multocida in 15/16 animal bites, Eikenella corrodens associated to streptococcus in 5/6 human bites, Fusobacterium spp. (5), Bacteroides spp. (3) and Peptococcus sp. (1). The most frequently administered antibiotics were gentamycin (15), penicillin (13), cloxacillin (5) and clindamycin (4). The evolution was favorable, although slow in many cases, with sequelae in 3 patients. CONCLUSIONS: It is very difficult to foresee in which cases infectious complications will develop in bite wounds. According to the authors' experience, in the case of deep wounds the bacteria implied come from the mouth of the aggressor. Careful cleansing, rapid administration of an adequate antibiotic and clinical control being the most recommendable procedure.

Adult↗
PubMed1993

[Bacteremia caused by Mycobacterium tuberculosis and/or Mycobacterium avium detected by the non-radiometric Bactec system].

BACKGROUND: To assess the utility of Bactec non-radiometric system in detecting disseminated mycobacteremia. METHODS: Blood cultures are processed using the Bactec NR 660/HPS system. Incubation of the NR6A vials, from HIV infected patients, is prolonged for 6 weeks and read once a week. After the 14th day of incubation a growth value > or = 30 is considered positive. RESULTS: Mycobacteria were recovered from 80 blood cultures from 32 human immunodeficiency virus infected patients. The mean time required to detect growth was 37.8 days (range 20-45). Mycobacterium tuberculosis was isolated from 18 patients and Mycobacterium avium from 14. In 12 patients (37.5%) blood culture was the first or the only positive specimen. CONCLUSIONS: Prolonged incubation of NR6A medium has proved to be a suitable method for detecting mycobacteremia.

Adult↗
PubMed1992

[Psoas abscess: diagnostic and therapeutic usefulness of echography and computerized tomography].

BACKGROUND: Psoas abscess (PA) is a clinically infrequent entity. The abscess may form spontaneously (primary PA) or as a complication of contiguous infection (secondary PA). The use of ultrasonography (US) and computerized tomography (CT) facilitates diagnosis and treatment of a disorder which previously required surgery. METHODS: Nineteen cases of PA diagnosed over the last 7 years were retrospectively studied. Confirmation of diagnosis was established by exteriorization of pus with US, CT or during surgery. RESULTS: Three primary PA (16%) and 16 secondary PA (84%) were diagnosed. The foci of origin of the secondary PA were: urologic (50%), rachydeal (25%), gastrointestinal (12.5%) and iatrogenic lumbar infection (12.5%). The most frequent germs in the primary PA were: Staphylococcus aureus (67%) and in the secondary PA, enterobacteriae (50%). The diagnostic profitability of US was 41% (7/17) and for CT was 100% (15/15). Percutaneous drainage was performed in 9 patients which failed in 2 cases due to compactness of pus (22%) and in another 2 because of undiagnosed osteomyelitis (22%). Two patients (10%) with underlying disease died despite adequate medical-surgical treatment. CONCLUSIONS: Psoas abscess were secondary in 84% of the patients studied with most being due to enterobacteriae. The diagnostic profitability of computerized tomography was greater than that of ultrasonography (100% vs 41%). Percutaneous drainage is a valid therapeutic alternative. Relapse observed in this study was due to previously undiagnosed osteomyelitis.

Adolescent↗
PubMed1992

[Bacterial peritonitis in cirrhosis. Prospective study of 80 episodes].

BACKGROUND: The high incidence, recognition of the different variants and the important changes introduced in the methods of diagnosis of bacterial peritonitis of cirrhotic patients led the authors to study this entity according to the most up to date and standardized criteria. METHODS: The clinical-epidemiological, biological and bacteriological characteristics of 80 episodes of ascitic fluid infection (AFI) were studied. Diagnostic paracentesis was performed in all the patients and were evaluated according to a prospective study protocol. RESULTS: The patients with AFI were classified into three groups: 1) spontaneous bacterial peritonitis (SBP) (761 episodes); 2) secondary bacterial peritonitis (BP) (5 cases); and 3) bacteriascitis (BA) (4 episodes). The clinical manifestations were not specific, with absence of abdominal pain and fever in 9% of the cases. There were no clinical differences between the variants of AFI. The ascitic fluid culture was positive in 80% of the cases of SBP while it was only so in 9% of the Gram stain. Most of the cases of peritonitis were caused by Gram negative bacilli (77%), predominantly E. coli (64%). The culture was positive in 100% of the cases of BP, generally being polymicrobian, and Gram stain was positive in 67% of the cases. The inflammatory response of the ascitic fluid in the different variants of AFI was gradual, being lower in BP and nul in BA. In 52 episodes of SBP (73.8%) the infection was cured. In the group of SBP all the patients died without having resolved the peritonitis (p < 0.001). Forty-four patients (62%) with BP were discharged from hospital. A multivariate logistic regression analysis demonstrated that from a total of 32 variables analyzed, only the absence of fever (p < 0.0001), the presence of advanced hepatic encephalopathy (p < 0.0001), the presence of leukocytosis, serum bilirubin higher than 137 mumol/l, urine sodium levels lower than 10 mmol/l, the level of LDH in ascitic fluid higher than 2 microKat/l and ascitic fluid culture positivity had independent prognostic value. CONCLUSIONS: Infection of ascitic is a frequent entity. Although its variants are clinically indifferentiable, there are clear biochemical, bacteriological and evolutive differences. The mortality of ascitic fluid infection remains high. Its prognosis fundamentally depends of the degree of evolution of the hepatopathy and the severity of the peritoneal infection.

Aged↗
PubMed1992

Value of differential quantitative blood cultures in the diagnosis of catheter-related sepsis.

A prospective study was performed to assess the value of differential quantitative blood cultures in the diagnosis of catheter-related sepsis when this condition is suspected on clinical grounds and to establish a reliable discriminative value for application without removal of the inserted catheter. A total of 107 central venous catheters from 64 patients were used for the study. Blood was obtained simultaneously through the suspected infected device and from a peripheral venipuncture. The catheter was removed and its tip cultured semiquantitatively. Catheter-related sepsis occurred in 17 patients. Using as cut-off value a colony count fourfold higher in blood drawn through the catheter than in simultaneously drawn peripheral blood, a sensitivity of 94%, specificity of 100% and positive predictive value of 100% were obtained. A single bacterial count greater than 100 cfu/ml in the quantitative culture of the catheter blood specimen in the presence of a positive qualitative peripheral blood culture of the same organism was also highly suggestive of catheter-related sepsis. Differential quantitative blood culture is a reliable method for the diagnosis of catheter-associated sepsis without catheter removal.

Bacteremia↗
PubMed1990

[Meningitis caused by Staphylococcus aureus. Analysis of 16 cases].

During the period between 1982 and 1987, 16 cases of meningitis due to Staphylococcus aureus were diagnosed. Nine patients (56%) had undergone a previous neurosurgical operation and 5 of them were carriers of a cerebrospinal fluid (CSF) shunt. Seven patients (44%) had spontaneous meningitis. Fever and meningeal signs were the most common clinical findings. 50% of patients were comatose. The Gram stain of CSF showed Gram positive cocci in 7 cases. Blood cultures were positive in all patients with spontaneous meningitis and negative in the neurosurgical group. Overall mortality rate was 37.5%, and it was lower in the neurosurgical group than in the spontaneous meningitis. Other factors associated with a poor outcome were advanced age, bacteremia and septic shock.

Adolescent↗