Enterobacter cloacae: bacteremia, epidemiology, and antibiotic resistance.
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Burns↗
Biomedical subjects
J F John
Publications and source records attributed to J F John.
Plasmids as epidemiologic markers in nosocomial gram-negative bacilli: experience at a university and review of the literature.
Bacterial plasmids have become valuable markers for the comparison of strains of nosocomial gram-negative bacilli. The importance of plasmids in nosocomial infections is primarily due to their transferable antibiotic resistance genes (R plasmids), but other plasmid-mediated traits may eventually serve as potential markers. Stable cryptic plasmids have also served to relate outbreak strains, particularly nonfermenting strains of gram-negative bacteria. Klebsiella pneumoniae and Serratia marcescens have been the major plasmid-containing species in outbreaks involving single or multiple species. Outbreaks of single species with common plasmid patterns have included the Enterobacteriaceae, Pseudomonas aeruginosa, Pseudomonas cepacia, Ewingella americana, and Legionella pneumophila. Intrageneric spread of the same or similar R plasmids has nearly always occurred within the Enterobacteriaceae in large medical centers or Veterans Administration hospitals. High-risk nurseries and burn units have been conspicuous foci for R plasmid evolution. Hospital epidemiologists and clinical microbiologists will likely have an ever-increasing need to determine the plasmid content of gram-negative bacilli producing endemic and epidemic nosocomial infections.
Bacterial Infections↗
Endocarditis associated with disseminated group B streptococcal infection.
Endocarditis due to group B streptococci occurred in two men associated with meningitis in one and septic arthritis in the other. Therapy with penicillin failed in the first patient necessitating aortic valve replacement. Clindamycin therapy was not curative in the second and the patient responded to a four-week course of vancomycin therapy.
Aged↗
Characteristics of gentamicin resistance in nosocomial infections.
Characteristics of gentamicin resistance were studied in gram-negative bacilli from 50 consecutive patients with nosocomial infection, during a time when gentamicin resistance had recently become prevalent at Medical University Hospital. Burns, decubitus ulcers, and cystic fibrosis were common precipitating factors for acquisition of gentamicin-resistant organisms. Pseudomonas aeruginosa accounted for 76% and Enterobacteriaceae for 24% of isolates. There was high prevalence of cross-resistance to amikacin (61%) and tobramycin (58%). Of the P aeruginosa strains 36% possessed plasmids which were rapidly detected by agarose gel electrophoresis. None of the isolates transferred gentamicin resistance. Representative isolates failed to elaborate aminoglycoside-modifying enzymes or to take up labelled amikacin. Multiple immunotypes of P aeruginosa were identified. These data suggest that a nonplasmid mediated resistance mechanism such as impermeability was responsible for the emergence of gentamicin resistance.
Amikacin↗
Endemic Serratia marcescens infection in a neonatal intensive care nursery associated with gastrointestinal colonization.
Serratia marcescens (SM) produced a prolonged outbreak in a neonatal intensive care unit of high level gastrointestinal colonization (10(9) SM/g feces) which in the early part of the outbreak predisposed to respiratory infection. The early outbreak featured a strain of SM carrying a 54 X 10(6) dalton conjugative plasmid which mediated resistance to gentamicin, tobramycin and beta-lactam agents. The second part of the outbreak involved primarily gastrointestinal colonization with SM strains that were plasmid-free. Acquisition of SM was related to very low birth weight (less than 1500 g). Among very low birth weight neonates, SM colonization was associated with pneumonia, patent ductus arteriosus, congestive heart failure and septicemia. Among neonates greater than 1500 g, SM colonization was associated with bronchopulmonary dysplasia, use of a respirator, patent ductus arteriosus and congestive heart failure. Respirator contamination, respiratory tract colonization and consequent pneumonia were reduced by more frequent changing of respirator tubing. Colonized sinks remained chronically colonized with multiresistant SM.
Anti-Bacterial Agents↗
Gonococcal endocarditis.
Three cases of endocarditis caused by Neisseria gonorrhoeae involving the aortic, mitral an tricuspid valves are reported. Two cases in young women, following syndromes suggestive of gonococcal arthritis, presented as acute endocarditis and were fatal. The male patient experienced a subacute course, and the diagnosis was suggested by finding an extremely high level of antigonococcal antibody. This old, though now rare, disease should be considered in the differential diagnosis in patients with histories of gonococcal illness and with findings of bacterial endocarditis.
Adolescent↗
Effect of inline filtration on postinfusion phlebitis.
The effect of inline i.v. filters on postinfusion phlebitis (PIP) and bacterial colonization of i.v. catheters was evaluated. The subjects of the prospective double-blind study were 195 men undergoing elective surgery. Polyethylene i.v. catheters of varying sizes were inserted the morning of surgery. Before catheterization, each site was shaved and cleansed with 1% povidone-iodine solution. In the experimental group, all i.v. fluids, additives, and medications were administered through a 0.22-micron micropore inline final filter. In the control group, no membrane filter was present in the filter housing. Drug and fluid therapy were determined by the physician, and flow rates were maintained at 40 ml/hr if not specified. Every 12 hours, sites were inspected and observations were graded according to criteria adapted from an earlier study. The incidence of phlebitis in the two groups was compared. At the termination of i.v. therapy, catheters were removed and cultured. The incidence of PIP in the experimental group (38/95) and the control group (39/100) was not significantly different. There were no differences between groups in variables possibly related to the occurrence of PIP, such as patient age, i.v. flow rate, catheter size, and use of potassium chloride i.v. additive. Of 141 i.v. catheters that were cultured, 25 yielded 10 or more colonies per plate; 21 were coagulase-negative staphylococci. Positive cultures occurred as frequently in patients without filters as in those with filters. No patient had clinical evidence of bacteremia. In these general surgical patients, inline filters did not affect the incidence of PIP or bacterial colonization of i.v. catheters. While the use of inline filters to prevent infusion of microorganisms deserves consideration, their routine use as a means of reducing PIP is unwarranted.
Adult↗
Old problems with new names.
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Cephalosporins↗