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Biomedical subjects

K B Crossley

Publications and source records attributed to K B Crossley.

At least 37 records · Page 2Linked to original sources
PubMed1985

Colonization of hospitalized patients by Staphylococcus aureus, Staphylococcus epidermidis and enterococci.

Patients admitted to a medical intensive care unit (29), a surgical intensive care unit (29) and a general medical ward (34) were studied to determine the frequency of colonization by Staphylococcus aureus, Staph. epidermidis and enterococci. Cultures of anterior nares, pharynx, axilla, periurethral tissues, and rectum were done within 24 h of admission and every 48-72 h thereafter for the duration of hospitalization. We found Staph. aureus colonization of pharynx, axilla, periurethral tissues and rectum to be equally frequent in patients with and without nasal colonization. Staphylococcus epidermidis was commonly recovered from all sites except the pharynx. The 49 strains of this organism acquired in the hospital were significantly more often resistant to nafcillin, cephalothin, chloramphenicol, trimethoprim-sulfamethoxazole and gentamicin than were 199 isolates recovered from patients at the time of admission. Enterococci were commonly isolated from rectal swabs and, less often, from other sites. Acquisition of enterococcal colonization during hospitalization was correlated significantly with antibiotic administration.

Anti-Bacterial Agents↗
PubMed1984

Antibiotic prophylaxis in surgery: improvement after a multihospital educational program.

The use of antibiotic prophylaxis in surgical patients was evaluated in studies before and after an educational program designed to improve the appropriateness of surgical prophylaxis. The first study included 1,021 patients hospitalized in 27 institutions. The repeat study involved 949 patients hospitalized in 24 of these 27 hospitals. After the educational campaign, there was no change in the proportion of patients who received antibiotic prophylaxis for clean operative procedures. However, the proportion of patients in whom antibiotic prophylaxis was initiated within four hours of skin incision (41% vs 65%, P less than .001), the mean duration of of antibiotic prophylaxis (2.5 days vs 3.4 days, P less than .01), and the proportion of patients who met both of these study criteria (31% vs 53%, P less than .001) all had significantly improved. Multihospital educational programs may, at relatively low cost, result in modification of physicians' antibiotic prescribing.

Anti-Bacterial Agents↗
PubMed1984

Susceptibilities of enterococci to twelve antibiotics.

The susceptibilities of 347 urine isolates of enterococci (Streptococcus faecalis, 44%; S. faecalis subsp. zymogenes, 37%; S. faecalis subsp. liquefaciens, 19%) to ampicillin, azlocillin, mezlocillin, piperacillin, vancomycin, gentamicin, erythromycin, rosaramicin, rifampin, rifampin plus trimethoprim (1:4), trimethoprim-sulfamethoxazole (1:20), and chloramphenicol were determined by the agar dilution technique. There were no significant differences in susceptibility to individual agents among the subspecies of S. faecalis. Azlocillin and mezlocillin (MIC for 90% of isolates, 0.78 micrograms/ml) and piperacillin, ampicillin, and vancomycin (MIC for 90% of isolates, 1.56 micrograms/ml) were the most active agents and were significantly more potent than the other reference antibiotics tested.

Anti-Bacterial Agents↗
PubMed1983

Clinical use of a one-compartment model for determining netilmicin pharmacokinetic parameters and dosage recommendations.

To determine netilmicin pharmacokinetic parameters and to evaluate the use of a one-compartment pharmacokinetic model, 32 patients receiving netilmicin for suspected gram-negative sepsis were enrolled in our study protocol. Dose and dosage interval for each patient were determined by one-compartment pharmacokinetic analysis of six postinfusion netilmicin serum samples (0.16, 0.33, 0.5, 1, 2, and 3 h) measured by radioimmunoassay. In patients with a normal serum creatinine, mean (+/- SD) half-life and distribution volume were 1.9 +/- 1.1 h and 0.2 +/- 0.8 L/kg, respectively. The average daily dose and mean days of therapy were 5.1 +/- 1.9 mg/kg/day for 7.3 +/- 2.8 days. Serum creatinine changes of greater than 0.5 mg% occurred in 2 of 28 (7%) patients. Substantial variability in half-life and distribution volume occurred in patients. Initial dosages of 5-7 mg/kg/day in divided dosages seem appropriate for adult patients with normal renal function. Monitoring of serum levels and adjustment of dose and dosage interval are necessary to maintain therapeutic antibiotic concentrations. As with other aminoglycosides, the one-compartment pharmacokinetic model proved to be an acceptable method for measuring netilmicin pharmacokinetic parameters and individualizing therapy.

Adolescent↗
PubMed1983

Ceftriaxone therapy of serious bacterial infections in adults.

We evaluated the efficacy and safety of ceftriaxone in 50 adults with serious infections, usually giving 1 g every 12 h. Of the 35 patients who could be evaluated for clinical efficacy, 15 had failed on previous therapy, 15 had nosocomial infections, and all but 1 had underlying diseases. One patient had three sites of infection. Favorable responses were seen in 34 of 37 infections, including 11 of 13 respiratory tract infections, all 7 urinary tract infections, all 12 skin and soft tissue infections, 1 of 2 bone and joint infections, a catheter-related septicemia, a liver abscess, and an otitis media and externa. Favorable bacteriological responses were seen for 48 of 58 organisms. This included 6 of 7 Staphylococcus aureus strains, 14 of 16 other aerobic gram-positive cocci, 18 of 20 Enterobacteriaceae, 6 of 9 Pseudomonas aeruginosa, and 1 of 2 anaerobes. Peak plasma ceftriaxone levels on day 1 were 152 micrograms/ml by bioassay and 78 micrograms/ml by high-pressure liquid chromatography. Four of the 31 initial isolates of aerobic gram-negative rods developed resistance to ceftriaxone on disk diffusion testing. Diarrhea occurred in 3 of 50 patients. All three had received a higher than usual dose. Drug administration was stopped twice, once for a thrombocytopenia and once for a thrombocytopenia with leukopenia. Neither problem could be attributed exclusively to ceftriaxone. Other adverse reactions were eosinophilia, abdominal pain, inguinal candidiasis, and nonsuppurative phlebitis. Even among debilitated adults, ceftriaxone was safe and effective in a twice daily regimen.

Adolescent↗
PubMed1981

Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison.

Using a standardized method, we estimated concurrently the prolongation of stay and extra charges attributable to nosocomial infection in three hospitals that differed in size, administrative characteristics and patients' economic status. Results showed the consequences in the three hospitals to have been similar in the degree to which nosocomial infection prolonged hospitalization (3.1 to 4.5 days) and added to the infected patients' charges ($590 to $641 in 1976 dollars). In all three hospitals, the extra charges were divided about equally between routine and ancillary charges, and a relatively small percentage of patients (10 percent) with nosocomial infection accounted for a disproportionately large share of the total extra charges--46, 65 and 38 percent in the three hospitals, respectively. The economic consequences were influenced more by site of infection than by differences among hospitals, and their magnitude emphasizes the need for continued preventive efforts.

Adult↗
PubMed1981

Staphylococcus aureus infection of dialysis shunt: absence of synergy with vancomycin and rifampin.

A 69-year-old man with chronic renal failure maintained on twice weekly hemodialysis had infection of the vascular access graft with bacteremia due to Staphylococcus aureus. Despite serum vancomycin levels that greatly exceeded the mean inhibitory and bactericidal concentrations, he failed to respond and rifampin was added. The bacteremia promptly cleared, but the patient died suddenly eight days later. Autopsy showed an acute arteritis of the graft with intracellular gram-positive organisms; two splenic blood cultures grew S aureus. Although previous investigators have shown that the combination of vancomycin and rifampin may be effective in some cases of S aureus endocarditis this antibiotic combination should not be used routinely unless in vitro synergy is demonstrated.

Aged↗
PubMed1981

Moxalactam therapy for a wide spectrum of bacterial infections in adults.

We evaluated the efficacy and toxicity of moxalactam during treatment of 45 documented infections in 36 patients. A majority of patients received 4.5 g of moxalactam per day. There was a good clinical response in 42 of the 45 (94%) infections, including 3 bacteremias, 20 skin and soft tissue infections, 6 gram-negative lower respiratory tract infections, 6 purulent diabetic foot ulcers, 3 wound infections, 3 urinary tract infections, and 4 miscellaneous infections (meningitis, suppurative phlebitis, peritonitis, bursitis). Previously, 11 of these patients had failed to respond to other antibiotics. Our three treatment failures were attributed to abnormal host defense in two patients and to a resistant enterococcal urinary tract infection in another. Moxalactam was tolerated well as produced minimal renal, hepatic, and hematological toxicities. The only serious adverse effect were the development of documented pseudomembranous colitis in one patient and progressive renal dysfunction in another. Acquisition of resistance among noneradicated isolates during therapy was not demonstrated.

Adult↗
PubMed1980

The accuracy of retrospective chart review in measuring nosocomial infection rates. Results of validation studies in pilot hospitals.

To measure the accuracy and consistency of a standardized method--retrospective chart review (RCR)--for estimating nosocomial infection rates (NIRs) in individual hospitals, the authors performed a series of pilot studies in four hospitals of different types. In comparison with a standard based on diagnoses made by physician-epidemiologists supervising intensive prospective data collection teams, the RCR method was found to have an average sensitivity of 0.74 (+/- 0.02 SE; range 0.69-0.78) and an average specificity of 0.964 (+/- 0.002; 0.945-0.991). These values were comparable to those of the physician-epidemiologists' diagnoses and varied less among the hospitals. Two independent teams of chart reviewers were found to have similar levels of sensitivity and specificity, and the reliability of diagnosis at the level of the individual chart reviewer averaged 0.94. In a restudy at one of the pilot hospitals at the midpoint of the actual Medical Records Survey (MRS), there was a substantial increase in sensitivityand a slight increase in specificity as a result of improvements made in the RCR method after the original pilot studies.

Cross Infection↗
PubMed1980

Effect of an infection surveillance and control program on the accuracy of retrospective chart review.

The primary analyses of the SENIC Project (Study on the Efficacy of Nosocomial Infection Control) will test the association between the presence of infection surveillance and control programs (ISCPs) and changes in nosocomial infection rates (NIRs) as measured by retrospective chart review (RCR). If the establishment of an ISCP affects the quality or completeness of information important for diagnosing infection by RCR, the analyses could be biased (i.e., there could be an increased chance of a Type I or Type II error). To determine whether this type of "ISCP effect" on the accuracy of RCR is likely to occur, the authors carried out a prospective intervention study in one hospital where 1) nosocomial infections among a pre-ISCP cohort of patients were detected by prospective data collection (PDC), 2) the hospital's first ISCP was instituted, and 3) infections were identically studied by PDC exactly two years later. Several months after the end of the second PDC, a team of trained chart reviewers read the medical records of the patients in both study cohorts and abstracted all clinical data bits used for diagnosing nosocomial infection. By a nonparametric matched correlation analysis, no significant change was found in the amount of relevant clinical information recorded in the medical records, and sensitivity and specificity did not change significantly. The authors conclude that, if an ISCP effect on RCR accuracy is present at all, it must be small.

Cross Infection↗
PubMed1980

Comparison of a radioimmunoassay and a microbiological assay for measurement of serum vancomycin concentrations.

A newly developed radioimmunoassay was used to measure the concentration of vancomycin in 137 specimens of serum from patients being treated with this antibiotic. Of these sera, 84 were also analyzed with a microbiological assay technique for vancomycin. Duplicate determinations were done with each of the techniques. Individual values and averaged values for both methods were used for statistical analyses. The correlation coefficients between all possible combinations of radioimmunoassay and microbiological assay results for the 84 sera were greater than or equal to 0.99 (P less than 0.01). Values for the regression coefficients of radioimmunoassay results on microbiological assay results ranged from 0.98 +/- 0.01 to 1.03 +/- 0.01. The mean percent deviation of radioimmunoassay versus microbiological assay results was -1.56 +/- 0.60. A one-way analysis of variance demonstrated that the use of different standard curves for each batch of specimens assayed by microbiological assay did not significantly influence the results (P = 0.07). The microbiological assay and the radioimmunoassay for measurement of serum vancomycin levels yielded essentially identical results.

Biological Assay↗
PubMedDate not supplied

The influence of serum albumin and alpha 1-acid glycoprotein on vancomycin protein binding in patients with burn injuries.

Ten patients with burn injuries (mean total body surface area burn = 29% +/- 16) were studied at various points in the course of their burn therapy. Alpha 1-Acid glycoprotein, albumin, and vancomycin concentrations were determined with either a trough or peak vancomycin quantitative determination. Alpha 1-Acid glycoprotein concentrations ranged from 125 to 333 mg/dl and albumin concentrations ranged from 1.7 to 4.2 gm/dl. Vancomycin protein binding, as determined by ultrafiltration, averaged 29% +/- 6%. There was a strong (r = 0.92) relationship between percent protein-bound vancomycin and albumin. There was a poor statistical relationship between percent protein-bound vancomycin and alpha 1-acid glycoprotein (r = 0.28). Alpha 1-Acid glycoprotein appeared to have virtually no effect on the protein-binding characteristics of vancomycin over the range of concentrations studied.

Adult↗