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Biomedical subjects

J H Tenney

Publications and source records attributed to J H Tenney.

At least 37 records · Page 2Linked to original sources
PubMed1986

Molecular epidemiology of group JK Corynebacterium on a cancer ward: lack of evidence for patient-to-patient transmission.

Plasmid profiles of 27 clinical isolates of group JK Corynebacterium, mostly from one cancer ward, revealed that only two strains harbored a 20-kilobase plasmid. These plasmid-bearing isolates had the same antimicrobial resistance pattern as non-plasmid-containing isolates: All were resistant to penicillin G, methicillin, cephalothin, clindamycin, and gentamicin. Restriction endonuclease analysis of chromosomal DNA was done on 18 clinical isolates of group JK Corynebacterium. Identical restriction patterns were seen when multiple isolates were from the same patient over several months of apparent colonization; in contrast, restriction patterns of isolates from patients from two clusters were all heterogeneous and suggested that patient-to-patient transmission of group JK Corynebacterium did not occur. Restriction endonuclease analysis of chromosomal DNA, but not plasmid profiling, appears to be a very sensitive typing tool for group JK Corynebacterium.

Corynebacterium↗
PubMed1986

Adherence to uroepithelial cells of Providencia stuartii isolated from the catheterized urinary tract.

The long-term catheterized urinary tract appears to offer a niche for Providencia stuartii, otherwise an unusual clinical isolate. P. stuartii, the most frequent and persistent isolate from the urine of 51 long-term catheterized patients, was recovered from 761 of 1230 (62%) weekly urine specimens. To test the hypothesis that prevalence of this species may be due to adherence properties of the organism, 20 selected strains from 14 patients at two nursing homes, representing six distinct serotypes and harbouring combinations of nine different plasmid species, were tested for adherence to uroepithelial cells (UEC). Optimal conditions were determined for differentiating strains on the basis of in vitro adherence to UEC. These strains, grown in nutrient broth, were incubated with UEC isolated from the urine of a healthy adult female (10(8) bacteria per 10(5) cells). Washed UEC, retained on 8 micron pore diameter filters, were transferred to slides, fixed and stained; bacteria were counted on each of 40 cells. Fourteen of the 20 strains were defined as adherent to UEC by comparison of mean adherent bacteria and percentage of uroepithelial cells with more than 10 bacteria. Adherence was compared to that of a P-fimbriated strain of Escherichia coli. It was not inhibited by 50 mM-mannose. We conclude that the majority of P. stuartii isolates are adherent to UEC in vitro and suggest that this may play a role in the persistence of this organism in the catheterized urinary tract.

Bacterial Adhesion↗
PubMed1986

Double-blind, prospective, multicenter trial comparing ceftazidime with moxalactam in the treatment of serious gram-negative infections.

Ceftazidime is a new antimicrobial agent possessing excellent in vitro activity against most members of the family Enterobacteriaceae and against Pseudomonas aeruginosa. We conducted a double-blind, prospective, multicenter trial to compare ceftazidime with moxalactam in the treatment of serious gram-negative infections. The overall favorable response rates for the two regimens were similar (93 of 106 [88%] and 84 of 97 [86%], respectively). Among these, the response rates of the 56 gram-negative bacteremias and the 23 P. aeruginosa infections were comparable. Both groups had similar incidences of subsequent infections with P. aeruginosa, enterococci, and yeasts. A total of 13% of the patients in the moxalactam group developed a prolonged prothrombin time (P less than 0.01), and three patients demonstrated clinical bleeding. These results suggest that although the overall efficacy of both regimens was similar, treatment with moxalactam resulted in a higher incidence of prolongation of prothrombin time with an attendant risk of bleeding. In nonneutropenic patients, ceftazidime as a single agent is safe and effective in gram-negative bacillary infections.

Adult↗
PubMed1986

Do clinical microbiology laboratories report complete bacteriology in urine from patients with long-term urinary catheters?

Bacteriuria associated with long-term urinary catheters (those in place for greater than or equal to 30 days) appears to be the most common nosocomial infection in U.S. medical care facilities. This bacteriuria is polymicrobial and dynamic and accompanied by fevers, catheter obstructions, bacteremias, and deaths. We compared the reporting by our research laboratory of bacteria present in urine from long-term-catheterized nursing home patients with that by two commercial laboratories. The commercial laboratories isolated significantly fewer bacterial species at 10(5) CFU/ml of urine specimen. Organisms well recognized as causes of urinary tract infections in noncatheterized patients (Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae) were isolated in comparable frequencies by both the research and commercial laboratories. However, other organisms, including uncommon uropathogens like Providencia stuartii and Morganella morganii, which were actually among the most frequent bacteriuric species in these long-term-catheterized patients, were isolated significantly less frequently by the commercial laboratories. Reasons for the discrepancies are unclear but may involve use of different techniques. More complete reporting may lead to better understanding of the polymicrobial bacteriuria of long-term catheters and its associated complications. This, in turn, may result in improved patient care and infection control in nursing homes.

Aged↗
PubMed1986

Bacterial infections of the central nervous system in neurosurgery.

CNS infections following clean neurosurgery are uncommon but occur with increased frequency following neurotrauma and placement of CSF shunts and ventriculostomies. When faced with the possibility of meningitis or brain abscess in these settings, the clinician must aggressively seek definitive diagnostic information by means of CT scanning and cell counts, Gram stain, and culture of the CSF. Appropriate empiric therapy should then be administered promptly to achieve cidal activity in the CSF against the most likely infecting pathogens. Prophylaxis for clean neurosurgery and for placement of CSF shunts has been advocated by several investigators. However, regimens are many, and data are few and conflicting. When given, prophylaxis should be administered only during the intraoperative period. There is, at best, a weak scientific basis for what remains a widespread practice.

Anti-Bacterial Agents↗
PubMed1986

A randomized controlled trial of moxalactam versus clindamycin/tobramycin in the treatment of mixed anaerobic/aerobic infections.

Many infections are due to mixtures of facultative gram-negative bacilli and anaerobic bacteria. Moxalactam, a semisynthetic beta lactam antibiotic, is active against a wide range of anaerobic organisms, including most strains of Bacteroides fragilis, as well as many aerobic gram-negative bacilli. We performed a prospective, randomized controlled trial comparing moxalactam alone with the regimen of clindamycin and tobramycin for treatment of mixed aerobic/anaerobic infections. One hundred and six patients with presumed mixed infections were randomized to the study groups. The resultant groups were clinically and microbiologically comparable. The effectiveness of treatment was similar with both antibiotic regimens. Five of 25 patients tested in the moxalactam group had a prolongation of their prothrombin time and one of them developed clinically important bleeding. Two of the 23 patients tested in the clindamycin/tobramycin group had a prolonged prothrombin time with no bleeding. Decreases in hematocrit which could be "probably" or "possibly" related to antimicrobial use were seen in 6 of 48 moxalactam patients and none of 50 clindamycin/tobramycin patients (P = .03). Moxalactam, a potent antimicrobial for both anaerobic and aerobic organisms, demonstrated effectiveness in treating mixed anaerobic/aerobic infections similar to clindamycin/tobramycin but was associated with clinically important decreases in hematocrit.

Bacterial Infections↗
PubMed1986

Adherent microorganisms on lumenal surfaces of long-term intravenous catheters. Importance of Staphylococcus epidermidis in patients with cancer.

Using electron microscopy, we prospectively evaluated how frequently adherent microorganisms colonized silicone rubber intravenous (Hickman) catheters removed from patients with cancer. Thirteen (87%) of 15 catheters had gram-positive cocci in glycocalyx adherent to the surface of the catheter lumen. Fungal elements or gram-negative bacilli were mixed with the gram-positive cocci in the glycocalyx on the lumens of three catheters. A consistent morphologic form was adherent to, and the same species was recovered from, the corresponding catheter for six of 27 organisms causing septicemia during catheterization: four of five Staphylococcus epidermidis bacteremias and the only Staphylococcus aureus bacteremia, and one of five candidemias. Three of these six septicemias were successfully treated without removal of the catheter. Although adherent organisms, particularly S epidermidis, were likely to be present on the surface of the lumen of long-term, indwelling, silicone intravenous catheters, septicemias potentially related to these organisms occurred infrequently (fewer than two per 1000 days of catheter use), and the suspect septicemias could sometimes be treated without removal of the catheter.

Adult↗
PubMed1985

How frequent are outbreaks of nosocomial infection in community hospitals?

A statistical algorithm was used to identify potentially important clusters among nosocomial infections reported each month by 7 community hospitals. Epidemiologic review and on-site investigations distinguished outbreaks of clinical disease from factitious clusters. In 1 year, 8 outbreaks were confirmed. They involved 82 patients--approximately 2% of patients with nosocomial infections and 0.09% of all discharges. One true outbreak occurred for every 12,000 discharges--at least 1 outbreak per year for the average community hospital. Five (63%) outbreaks were recognized independently by the hospitals' infection control personnel. Four (50%) resolved spontaneously; the hospitals' own control measures were necessary in 2; and 2 resolved only after an outside investigation. Organized surveillance appears necessary to detect some outbreaks, and control measures are needed to stop many. Since, however, outbreaks account for such a small proportion of nosocomial infections, infection control programs should be sufficiently staffed and managed so that most of the effort is directed toward the surveillance and control of endemic infection problems, but with adequate resources remaining to respond to outbreaks when they occur.

Cross Infection↗
PubMed1985

Intestinal Salmonella carriage in patients with major sickle cell hemoglobinopathies.

The increased incidence of Salmonella osteomyelitis in patients with sickle cell disease has never been entirely explained. Problems such as cholelithiasis, intestinal infarction, and frequent antibiotic use in this population could possibly result in prolonged or chronic intestinal carriage of Salmonella after acute gastroenteritis. If prolonged carriage were a factor in the pathogenesis of osteomyelitis, attempts to eliminate the Salmonella with antibiotics would be indicated. We did a stool culture survey of 71 patients attending our pediatric sickle cell clinic to determine the incidence of asymptomatic Salmonella carriage. At least two rectal swab cultures were obtained from each patient; 69% of patients also mailed in a stool sample for culture. No Salmonella was isolated. It therefore appears unlikely that prolonged intestinal Salmonella carriage is an important mechanism in the development of Salmonella osteomyelitis in patients with major sickle hemoglobinopathies.

Adolescent↗
PubMed1985

In vitro susceptibility of pathogenic Vibrio species to norfloxacin and six other antimicrobial agents.

The in vitro activity of norfloxacin and six other antimicrobial agents was tested against 93 vibrio strains representing the currently described pathogenic Vibrio species. Norfloxacin had excellent activity against all species, with the following MICs for 90% of the strains: 0.016 micrograms/ml for Vibrio cholerae (including tetracycline-resistant V. cholerae O1 strains), 0.25 micrograms/ml for V. parahaemolyticus, and 0.063 micrograms/ml for V. vulnificus.

Ampicillin↗
PubMed1985

Variable phenotypes of Providencia stuartii due to plasmid-encoded traits.

Weekly urine specimens from 51 long-term catheterized patients yielded 699 isolates of Providencia stuartii. Urease-positive strains represented 23.7% (166) of the isolates, sucrose-positive strains represented 24.5% (171), and lactose-utilizing strains represented 0.7% (5). Urease and sucrose traits were transferred by conjugation to Escherichia coli via an 82-kilobase plasmid; lactose fermentation was transferred by a 150-kilobase plasmid.

Bacteriuria↗
PubMed1985

Wide variation in risk of wound infection following clean neurosurgery. Implications for perioperative antibiotic prophylaxis.

The authors have prospectively examined the occurrence of postoperative wound infection following clean neurosurgery in 936 patients. Fewer than 1% received perioperative antibiotic prophylaxis. The overall rate of deep wound infection was 2.6%; no deaths were directly attributable to these infections. Deep wound infections occurred significantly more frequently following craniotomy (4.3%) than following spinal (0.9%) or other clean neurosurgery. Among craniotomies, the deep wound infection rate varied significantly from 11% following repeat operations for recurrent gliomas to 2.5% following non-tumor surgery. Risk of deep wound infection varied more than 11-fold depending on the type of clean neurosurgical operation. It is most feasible to demonstrate the potential efficacy of perioperative antibiotics in clean neurosurgical procedures with the greatest risk of postoperative wound infection. The potential benefit from such prophylaxis would be greatest for patients undergoing these high-risk operations.

Adult↗
PubMed1985

Botulism and botulism-like illness in chronic drug abusers.

From 1982 to 1983 we received reports of a neurologic illness characterized by a symmetric descending paralysis in six drug abusers from widely separated geographic areas. Botulism was confirmed in two patients; type B botulinal toxin was found and Clostridium botulinum was isolated from a small abscess in one, and type A botulinal toxin was found in the serum of the other. The clinical illness in the remaining four patients, although not laboratory confirmed, was also compatible with botulism. None of the patients had histories suggestive of foodborne botulism, and wound botulism was suspected as the cause of illness. There are several reports of tetanus associated with parenteral drug abuse; wound botulism is another toxin-mediated clostridial infection that may occur as a complication of chronic drug abuse.

Abscess↗
PubMed1985

Autopsy findings after prolonged catheterization of the right atrium for chemotherapy in acute leukemia.

Autopsies performed upon 59 patients treated for acute leukemia through venous access provided by long term right atrial catheters demonstrated a significant incidence of thrombus formation in the vena cava or right atrium. Similar thrombi were not present in 49 patients who were treated for the same disease without long term catheters. The clinical significance of these lesions, which were not usually seen with less than 150 days of catheter use, is unclear. No increase in the likelihood of other pathologic lesions, specifically of pulmonary emboli, was seen to accompany thrombus formation nor did they seem in any way contributory to the demise of the patient. No good screening test is yet available to detect these lesions ante mortem.

Adolescent↗
PubMed1984

Can antibacterial therapy be discontinued in persistently febrile granulocytopenic cancer patients?

It has been suggested that empiric broad-spectrum antibiotics, instituted for fever in the presence of granulocytopenia, should continue to be administered, even when infection is not demonstrable, to those patients who remain persistently febrile and granulocytopenic. Therefore, the consequences of discontinuing antibiotics when the presence of infection is doubted in this setting were evaluated. In 16 (3.7 percent) of 429 episodes of fever and granulocytopenia for which empiric antibiotic therapy was instituted, after approximately four days, persistence of both fever and granulocytopenia was found, and yet infection was prospectively classified at that time as "doubtful." The initial empiric antibiotic regimen was therefore discontinued after a mean of 4.8 (median 5.0) days. Discontinuation of antibiotics proved appropriate for half of the patients; eight patients received no systemic therapeutic antibiotics with no evidence of infection during a period of at least two weeks. The other eight patients had antibacterial antibiotics reinstituted within a mean of 2.4 days; six infections were subsequently demonstrable. Six of these eight patients also required or were believed to require antifungal therapy with intravenous amphotericin B for presumed fungal infections. Patients with relapsed leukemia or lymphoma and those with a likelihood of continued profound granulocytopenia (counts below 100/microliters) or both were the ones who tended to require reinstitution of antibiotics. Discontinuation of antibiotics when infection was considered doubtful despite persistence of both fever and granulocytopenia was, therefore, successful in eight of 16 patients. Reinstitution of antibiotics was required in the eight remaining patients. No definite rule appears to be applicable to all patients.

Agranulocytosis↗
PubMed1984

Persistent isolation of an unusual Pseudomonas species from a phenolic disinfectant system.

A well-characterized unusual Pseudomonas species contaminated the piped disinfectant system of a newly-opened laminar air flow intensive care facility. This organism was frequently isolated (10(4)-10(6) cfu/ml) from phenolic diluted 1:256 in the system, and could also be recovered (0.01-0.2 cfu/ml) from undiluted phenolic. During the 20-month period when this unusual Pseudomonas was present, none of the severely compromised, granulocytopenic oncology patients treated in the intensive care facility were either colonized or infected with this Pseudomonas sp. Eradication of the organism from the system proved difficult and was accomplished by removing a contaminated reservoir of diluted phenolic disinfectant followed by transient cleansing of the system with very high concentrations (84,000 ppm) of chlorine. This experience demonstrates that phenolics should be added to the list of disinfectants which can harbor Pseudomonas spp. in the clinical setting.

Air Microbiology↗