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Biomedical subjects

J C Wade

Publications and source records attributed to J C Wade.

87 records · Page 5Linked to original sources
PubMed1981

Selective suppression of alimentary tract microbial flora as prophylaxis during granulocytopenia.

Oral nonabsorbable antibiotics have been used to suppress the rectal flora in granulocytopenic patients. Problems with these therapies, i.e., compliance, acquisition of undesirable flora, and cost, motivated the search for an alternative therapy which would increase compliance and effectively reduce the Enterobacteriaceae without creating a microbiol vacuum. Trimethoprim-sulfamethoxazole was found to be easily taken, to suppress the Enterobacteriaceae, and to maintain the anaerobic rectal flora for biological stability of the rectal ecosystem. However, concurrent use of parenteral antibiotics profoundly influenced rectal flora and temporarily destroyed the colonization resistance afforded by the anaerobes.

Agranulocytosis↗
PubMed1980

Potential of mezlocillin as empiric single-agent therapy in febrile granulocytopenic cancer patients.

Mezlocillin was used as an initial empiric antibiotic therapy for febrile (> 101 degrees F, ca. 38.33 degrees C) granulocytopenic (< 1,000/microliter) cancer patients. Patients known to be colonized with an organism resistant to 100 micrograms of mezlocillin per mol were excluded. The initial 25 cases (23 patients) received intravenous mezlocillin, 260 mg per kg per day in six divided doses; the mean 1-h-postinfusion serum level was 69 micrograms/ml. Because of the low serum level, the next 25 cases (22 patients) received 450 mg/kg per day, also in six divided doses, resulting in a mean 1-h-postinfusion serum level of 161 micrograms/ml. Both dosage regimens provided similar efficacy. Combined results show that 11 of 21 microbiologically documented infections and 7 of 13 clinically documented infections improved. Instances of bacteremia (number of cases in parentheses) were caused by Pseudomonas aeruginosa (two), Staphylococcus epidermidis (two), Clostridia perfringens (one), and Bacillus species (one); only one case improved. A rise in granulocyte count to > 500/microliters, a serum bactericidal activity of greater than or equal to 1:8 against the infecting pathogen, or both were indicators of a good therapeutic response. Despite exclusion of patients known to be previously colonized with mezlocillin-resistant organisms, 7 of 23 pathogens required a minimal concentration of greater than or equal to 100 micrograms of mezlocillin per ml for inhibition. In addition, surveillance cultures from 18 cases showed resistant organisms colonizing the gingiva, rectum, or both. Side effects of mezlocillin were minimal and included pseudoproteinuria, asymptomatic transient rise in bilirubin, and easily reversible kypokalemia. Mezlocillin, a new semisynthetic penicillin with little toxicity, was found to be inadequate as a single-agent empiric antibiotic therapy for febrile, granulocytopenic cancer patients.

Adult↗
PubMed1978

Cephalothin plus an aminoglycoside is more nephrotoxic than methicillin plus an aminoglycoside.

In a prospective, randomised, double-blind trial to determine if cephalothin plus an aminoglycoside is more nephrotoxic than methicillin plus an aminoglycoside, patients were assigned to one of four treatment groups: cephalothin and gentamicin (C.G.), cephalothin and tobramycin (C.T.), methicillin and gentamicin (M.G.), or methicillin and tobramycin (M.T.). The incidence of definite nephrotoxicity was: C.G., 7/23 (30.4%); C.T., 5/24 (20.8%); M.G., 2/20 (10%); and M.T., 1/23 (4.3%). There was no statistically significant difference in nephrotoxicity between the combined gentamicin groups (C.G. and M.G.) and the combined tobramycin groups (C.T. and M.T.). Definite nephrotoxicity developed in 12/47 (25.5%) of the combined cephalothin groups (C.G. and C.T.) and in only 3/43 (7%) of the combined methicilllin groups (M.G. and M.T.). The combination of cephalothin plus an aminoglycoside is therefore more nephrotoxic than the combination of methicillin plus an aminoglycoside.

Acute Kidney Injury↗
PubMed1978

Double-blind comparison of cefamandole and penicillin in pneumococcal pneumonia.

We conducted a prospective, randomized, double-blind comparison of intravenous penicillin and cefamandole in the therapy of pneumococcal pneumonia. Patients received either 1 g of cefamandole or 600,000 U of aqueous penicillin G every 6 h. Of the 100 patients entered into the study, 96 had clinical and radiographic evidence of pneumonia. Microbial etiology was determined from the results of sputum and blood cultures and/or sputum Gram stains. Streptococcus pneumoniae was pathogenic in 49 patients, of whom 24 received cefamandole and 25 received penicillin. There was no statistically significant difference in the response or cure rate. Of the 100 patients, 93 were treated for 3 days or more and were evaluated for adverse effects and toxicity. There was no significant difference between cefamandole-treated and pencillin-treated patients in the incidence of colonization, superinfection, phlebitis, thrombocytosis, decrease in hematocrit, or elevated liver function tests. Eosinophilia occurred more frequently in patients treated with penicillin (20 of 42) than in those treated with cefamandole (11 of 42 (chi square, P < 0.05). Only one patient receiving cefamandole developed a positive direct Coombs test. No patient in either group developed meningitis. We conclude that, with the doses and route of administration employed in this study, cefamandole is as effective as penicillin in the therapy of pneumococcal pneumonia without an increased incidence of colonization, superinfection, or adverse effects.

Adult↗
PubMedDate not supplied

Early infectious complications in allogeneic marrow transplant recipients with acute leukemia: effects of prophylactic measures.

One hundred eighty-two patients with acute leukemia underwent allogeneic marrow transplantation and received one of two forms of infection prophylaxis: isolation and decontamination procedures in laminar air flow rooms (90 patients) or prophylactic granulocyte transfusion from a single family member (92 patients). Infection acquisition and survival were analyzed from the time of admission to 100 days posttransplant. There were 20 major local infections in the laminar air flow group and 16 in the prophylactic granulocyte group. Of the patients in the laminar air flow group, 24 (27%) had 27 episodes of bacteremia, while 23 (25%) of the prophylactic granulocyte group had 25 episodes of bacteremia. There were no significant differences in infection acquisition between the two groups during the period of granulocytopenia or after engraftment. The mortality during the first 100 days was 28% for the laminar air flow group and 35% for the prophylactic granulocyte group. Thirteen patients (14%) in the laminar air flow group and five (5%) in the prophylactic granulocyte group died with bacterial or fungal infections. There were no statistically significant differences between the two groups in overall incidence of or mortality from interstitial pneumonitis which was the predominant cause of death. However, the subset of patients who were seronegative for cytomegalovirus antibody at the time of transplant and received granulocytes from seropositive donors had a significantly higher incidence of and mortality from cytomegalovirus interstitial pneumonitis.

Acute Disease↗
PubMedDate not supplied

Antibiotic therapy for the febrile granulocytopenic cancer patient: combination therapy vs. monotherapy.

The specific composition of empiric antibiotic therapy to be implemented for patients with neutropenia and fever remains controversial. The available clinical data comparing antibiotic combination with monotherapy come from studies with a number of major differences in design and analysis that make it difficult to interpret relative efficacy. The standard practice has been to use an antibiotic combination demonstrating broad antibacterial coverage, additive or synergistic effects against the more virulent gram-negative pathogens, and potentially antibacterial activity that decreases the emergence of resistant organisms. Studies of monotherapy have been hindered by wide differences in study design, and few comparative data have been presented to substantiate the efficacy of the drug in question as "treatment of infection"--an exception being the new agent imipenem. The emergence of gram-positive organisms as frequent pathogens in neutropenic patients has raised concern regarding empiric gram-positive therapy. Clinical experience suggests that empiric therapy is unnecessary; rather, directed therapy with an agent such as vancomycin can be used in those situations in which clinical or microbiologic data suggest the need for such antibiotics. If the specifics of optimal management of infectious disease in patients with sustained neutropenia and fever are to be identified, many continuing clinical problems must be approached in a more systematic and defined manner. Defects in study designs of the past should be eliminated, with investigators taking a stronger stand in support of standardized design and analysis.

Agranulocytosis↗
PubMedDate not supplied

Enterprise-wide patient monitoring improves care efficiency and lowers costs.

The Mid America Heart Institute (MAHI), located at Saint Luke's Hospital and a member of the Saint Luke's-Shawnee Mission Health System (SLSMHS) in Kansas City, Missouri, has implemented a revolutionary enterprise-wide patient monitoring solution via a network that connects multiple hospitals to provide real-time patient monitoring--a lifeline of patient data. The underlying technical infrastructure creates the foundation necessary to link metropolitan and rural facilities with instant acute care patient information. The result is an electronic extension of the MAHI and its proven care expertise to several hospitals throughout the region. This approach has yielded MAHI/SLSMHS numerous efficiencies, including reduced costs and standardized monitoring quality across the enterprise. In the process, they have garnered some unanticipated benefits: unique marketing exposure and a new way to build alliances with other hospitals.

Cardiac Care Facilities↗