Hydrocephalus shunt infections and their treatment.
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Biomedical subjects
Publications and source records attributed to J H Andrew.
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Clinical specimens submitted for anaerobic culture to a Melbourne teaching hospital microbiology laboratory were plated onto 3 types of selective media, to determine which would allow the optimal recovery of anaerobic organisms. The 3 media employed were kanamycin agar (KA), neomycin agar (NA) and nalidixic acid-Tween 80 agar (NAT). The highest isolation rate was achieved on NAT, 89% of the total of all anaerobes isolated being recovered on this medium. A recovery rate of 69% was achieved using NA, while use of KA allowed the isolation of only 56% of all strains. The major difference between 3 media was in the recovery of anaerobic Gram-positive cocci, which accounted for 40% of the total isolates on NAT, 25% on NA, and only 11% on KA. The NAT was also more successful in the isolation of Fusobacterium and Veillonella species. The NAT medium failed, however, to recover Clostridium spp. that were isolated on both NA and KA. There was no significant difference between the 3 media in regard to the recovery of Bacteroides spp.
A 62 yr-old man with a recent history of dog bite and a past history of splenectomy developed septicemia and signs suggestive of a generalized Schwartzman reaction, including fever, hypotension, symmetrical peripheral gangrene and laboratory evidence of consumptive coagulopathy. The causative organism was a Dysgonic Fermenter-2 (DF-2), a designation given to an unnamed group of Gram-negative rod shaped bacteria. This organism has not previously been reported in Australia. A review of documented cases of serious infection suggests that splenectomy and dog bite are predisposing factors to disease caused by this organism.
The MIC values of 99 isolates of Enterobacteriaceae to 11 of the newer beta-lactam antibiotics, and 25 isolates of Pseudomonas aeruginosa to 9 of these drugs were compared with representatives of the established beta-lactam antibiotics and gentamicin. The MIC values for the newer agents were significantly lower in comparison with the older reference compounds. The potential clinical use of these newer antibiotics is discussed.
Branhamella catarrhalis, formerly regarded as an oropharyngeal commensal, has more recently been implicated as an opportunistic pathogen in the respiratory tract. This report describes the isolation of B. catarrhalis from two consecutive samples of empyema fluid and also from sputum in thirteen cases of lower respiratory tract disease, where the isolate was considered to be etiologically significant. The antibiotic therapy required to treat such infections is discussed.
An agar dilution technique was used to determine the MIC of pristinamycin for 124 clinical isolates of methicillin-resistant Staphylococcus aureus. All were inhibited by less than or equal to 0.5 mg/1, quite similar to the sensitivity of a number of methicillin-sensitive strains. MICs obtained using a microdilution method were also comparable. Antagonism was seen with the combination of pristinamycin and erythromycin.
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Over 250 strains of Staphylococcus aureus isolated from patients who presented with infections acquired outside the hospital were tested for susceptibility to penicillin G, minocycline and erythromycin. Only 15.5% of strains could be regarded as sensitive to penicillin, whereas 99.2% and 90.2% were sensitive to minocycline and erythromycin respectively. Beta-haemolytic streptococci were found in association with Staph. aureus in 17.5% of the lesions cultured in this survey. The susceptibility of a further 100 strains of methicillin-sensitive Staph. aureus to a wider range of antimicrobial agents was also examined.
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The incidental autopsy finding of an embolic fragment of skin partially occluding a pulmonary artery is described. It is suggested that the "graft" resulted from one of many needle punctures.
A case of terminal ileitis, mesenteric lymphadenitis and appendicitis is reported. Serological studies indicated infection with Yersinia pseudotuberculosis type VA. The patient's illness ran a chronic course necessitating resection of the terminal ileum. Histological examination of the appendix and a mesenteric lymph node in the acute stage revealed granulomas with central necrosis. This is the first human case in which the subtype VA has been identified.
The in vitro antimicrobial activities of tobramycin and gentamicin against 1400 bacterial isolates from clinical material were compared. The minimum inhibitory concentrations were determined by an agar dilution technique. Both of these aminoglycoside antibiotics had a similar spectrum of activity, being highly active against most species of aerobic Gram-negative bacilli and Staphylococcus aureus. Gentamicin was more active than tobramycin against most species of enterobacteria but tobramycin was more active against Pseudomonas aeruginosa and a proportion of Klebsiella isolates. For most isolates, the differences in activity between gentamicin and tobramycin were small.
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