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Biomedical subjects

K G Kerr

Publications and source records attributed to K G Kerr.

At least 19 recordsLinked to original sources
PubMed2006

Best practice in primary care pathology: review 7.

This seventh best-practice review examines four series of common primary care questions in laboratory medicine: (1) blood count abnormalities 2; (2) cardiac troponins; (3) high-density lipoprotein cholesterol; and (4) viral diseases 2. The review is presented in a question-answer format, with authorship attributed for each question series. The recommendations are a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. The recommendations are not standards, but form a guide to be set in the clinical context. Most are consensus based rather than evidence based. They will be updated periodically to take account of new information.

Biomarkers↗
PubMed2006

Best practice in primary care pathology: review 6.

This sixth best practice review examines four series of common primary care questions in laboratory medicine: (1) laboratory monitoring in hypertension and heart failure abnormalities; (2) markers of inflammatory joint disease; (3) laboratory investigation of chronic diarrhoea; and (4) mumps and chickenpox. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus based rather than evidence based. They will be updated periodically to take account of new information.

Arthritis↗
PubMed2006

Modelling the transmission of airborne infections in enclosed spaces.

The Wells-Riley equation for modelling airborne infection in indoor environments is incorporated into an SEIR epidemic model with a short incubation period to simulate the transmission dynamics of airborne infectious diseases in ventilated rooms. The model enables the effect of environmental factors such as the ventilation rate and the room occupancy to be examined, and allows the long-term impact of infection control measures to be assessed. A theoretical parametric study is carried out to demonstrate how changes to both the physical environment and infection control procedures may potentially limit the spread of short-incubation-period airborne infections in indoor environments such as hospitals.

Air Microbiology↗
PubMed2006

Best practice in primary care pathology: review 2.

This second best practice review examines five series of common primary care questions in laboratory medicine: (1) laboratory testing for allergy, (2) diagnosis and monitoring of menopause, (3) the use of urine cytology, (4) the usefulness of the erythrocyte sedimentation rate, and (5) the investigation of possible urinary tract infection. The review is presented in a question-answer format. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents, and evidence based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are standards but form a guide to be set in the clinical context. Most are consensus rather than evidence based. They will be updated periodically to take account of new information.

Blood Sedimentation↗
PubMed2005

Could hospital patients' hands constitute a missing link?

The relationship between contamination of patients' hands and transmission of healthcare-associated infection has received only limited attention, but may represent a previously overlooked but potentially significant link in the chain of infection. This paper aims critically to review the literature to determine whether this possible epidemiological relationship is worthy of further consideration. Studies that have investigated the microbiology or hand hygiene behaviours of patients and other groups are examined to establish their limitations and implications for future practice and research. Examples of healthcare-associated infections where improving patient hand hygiene may have a favourable impact on transmission, and how this might be achieved within the context of current UK health service initiatives, are discussed. It is recommended that systematic studies of the role of patients' hands in the chain of hospital infection should be undertaken.

Behavior↗
PubMed2005

Effects of zinc oxide and Enterococcus faecium SF68 dietary supplementation on the performance, intestinal microbiota and immune status of weaned piglets.

The objective of this study was to determine the effects of zinc oxide (ZnO) and the probiotic Enterococcus faecium SF68 (Cylactin) dietary supplementation on the performance, intestinal microbiota and immune parameters of the weaned piglet reared under commercial conditions. The diets were devoid of antibiotic growth promoters (AGP). Two hundred and eight crossbred piglets were allocated to a 2 x 2 factorial experiment involving two levels of zinc oxide supplementation (0 or 3100 mg ZnO/kg feed), and two levels of E. faecium SF68 supplementation (0 or 1.4 x 10(9)CFU/kg feed (Cylactin ME10)). The diets were offered ad libitum for 20 days post-weaning. Piglet performance was assessed by calculating average daily gain (ADG), average daily feed intake (ADFI) and feed conversion ratio (FCR) on a pen basis. In addition, components of the distal ileal digesta, tissue-associated and mesenteric lymph node (MLN) bacterial populations were enumerated and serum immunoglobulin G (IgG) and intestinal immunoglobulin A (IgA) concentrations were determined on days 6 and 20 post-weaning. Regression analysis was used to determine the relationship between the bacterial populations at the different sites. Supplementation of the post-weaning diet with either ZnO or E. faecium SF68 did not affect piglet performance. E. faecium SF68 did not affect gastrointestinal bacterial populations but did tend to reduce serum IgG (P<0.1) on day 20. Zinc oxide reduced anaerobic (P<0.05) and tended to decrease lactic acid (P<0.1) bacterial translocation to the MLN, and tended to increase intestinal IgA concentration (P<0.1) on day 20. Generally, luminal bacterial populations were found to be poor predictors of tissue-associated or MLN populations. ZnO and E. faecium SF68 dietary supplementation were ineffective under these trial conditions. Further investigations into the possible immunomodulator role of dietary ZnO are warranted.

Animals↗
PubMed2004

Provision of safe potable water for immunocompromised patients in hospital.

We conducted a survey of hospital drinking water provision for patients with immunocompromising conditions in 15 Trusts in the north of England. Ten trusts replied, reporting on provision of drinking water in 14 separate units. Of these, nine provided only tap water to all patients, irrespective of underlying condition. In two units, iced water, with ice from commercially available makers, was used. Five units distinguished between neutropenic and non-neutropenic patients, with the former group receiving cooled, boiled water (three units), sterile water and sterile water or carbonated water (one unit each). No unit provided filtered water. Water in jugs was changed daily, twice daily or only when empty in seven, three and four units, respectively. On 10 units, patients were allowed to provide their own drinking water, but no unit provided written advice to patients on potable water. A survey within our own Trust revealed similar inter-unit disparity. The options for potable water provision were reviewed, taking into account: microbiological quality, organoleptic (perceived taste/smell) acceptability, cost and factors relating to staff safety and patient confidentiality [as it was possible for human immunodeficiency virus (HIV) seropositive patients on some wards to be identified because they were provided with cooled, boiled water]. It concluded that end-line commercially available water filters were the optimal way to provide drinking water to immunocompromised patients in hospital.

Cross Infection↗
PubMed2003

Stenotrophomonas maltophilia contamination of nebulizers used to deliver aerosolized therapy to inpatients with cystic fibrosis.

There is circumstantial evidence that nebulizer equipment may be a source of Stenotrophomonas maltophilia for patients with cystic fibrosis. Eighty-nine inpatient nebulizers were examined for evidence of S. maltophilia contamination of which nine (10%) yielded 14 strains of the bacterium. Environmental samples were obtained from 73 different sites on the ward, of which 17 (23%) yielded a further 21 strains. Positive sites included taps, sink drains, and potable water. Genotyping using ERIC-PCR and pulsed-field gel electrophoresis revealed that two pairs of patients' nebulizers were contaminated with closely related strains. None of the S. maltophilia isolates obtained from the ward environment shared genotypes with those obtained from the nebulizers. The frequency of isolation of S. maltophilia from potable water sources on the ward suggests that contamination may result from using it to clean reusable nebulizer equipment, particularly if this is followed by inadequate drying. Although the actual source of S. maltophilia contamination of hospital-use nebulizer equipment in this study remained elusive, these results have important infection control implications.

Adolescent↗
PubMed2002

Differential invasion of respiratory epithelial cells by members of the Burkholderia cepacia complex.

To investigate whether there are differences between members of the Burkholderia cepacia complex in their ability to invade human respiratory epithelial cells, 11 strains belonging to genomovars I-V were studied in an antibiotic protection assay using the A549 cell line. Strains belonging to genomovars II and III were more invasive than those of genomovars I, IV and V. There was also intra-genomovar variation in invasiveness. No correlation between invasiveness and other putative virulence factors of importance in B. cepacia infection in individuals with cystic fibrosis, cable pilus and B. cepacia epidemic strain marker was identified.

Burkholderia cepacia↗
PubMed2002

Bacterial colonisation of Doppler probes on vascular surgical wards.

AIM: hospital acquired infections cost the NHS 1 pound sterling billion each year and medical equipment may act both as source and vector of nosocomial infection. This study examined bacterial contamination of Doppler ultrasound probes (USP) in routine use on vascular surgical wards in six hospitals and the knowledge of staff about the potential for cross infection from contaminated probes. METHODS: probe head impressions and swab cultures of probe holders were plated on mannitol salt agar before and after cleaning with a paper towel. Putative S. aureus isolates were identified to species level and susceptibility to selected antimicrobials tested. Concurrently, junior medical staff were surveyed about probe cleaning protocols. RESULTS: methicillin susceptible S. aureus was isolated from 2/21 (10%) with near confluent bacterial growth from six others (28%). The latter may have obscured low numbers of S. aureus. Further since swabs were plated without prior enrichment culture, it is likely that contamination with S. aureus might have been underestimated. No positive cultures were obtained after wiping the USP with a paper towel. 22/23 (95%) junior doctors failed to clean the USP prior to use. CONCLUSION: USP contamination with pathogenic bacteria occurs under "in-use" conditions and junior medical staff are unaware of simple measures to prevent this. Strict guidelines for USP cleaning between patient use should, therefore, be adopted particularly when monitoring postoperative graft patency.

Colony Count, Microbial↗
PubMed2001

Invasion of human type II pneumocytes by Burkholderia cepacia.

Burkholderia cepacia is known to invade and survive within respiratory epithelial cells. Previous studies have employed transformed cell lines and it is not known whether the bacterium is capable of manifesting the same phenomena in primary cell culture. Two strains of B. cepacia of environmental (NCTC 10661) and clinical origin (C1359) were examined for their ability to invade and survive (over a 24 h period) within type II pneumocytes in primary culture using a gentamicin-ceftazidime antibiotic protection assay. Both strains of B. cepacia were capable of invasion of type II pneumocytes in primary culture. Strain C1359 was capable of multiplying intracellularly as indicated by a seven-fold increase in the numbers of bacteria from 4-24 h, whereas strain 10661, although unable to replicate intracellularly, was found to survive in the pneumocytes for at least 24 h. Future studies on the invasiveness of B. cepacia can employ A549 cells as a valid surrogate for primary cell culture assays which are time-consuming, labour-intensive and expensive to perform.

Adult↗
PubMed2001

Survival of Stenotrophomonas maltophilia following exposure to concentrations of tobramycin used in aerosolized therapy for cystic fibrosis patients.

The use of aerosolized tobramycin is an important component in the management of patients with cystic fibrosis, particularly those with chronic Pseudomonas aeruginosa infection. Clinicians have been concerned that long-term therapy with aerosolized tobramycin may increase the risk of colonization with multi-resistant bacteria, including Stenotrophomonas maltophilia. The ability of five strains (three clinical, two environmental) of S. maltophilia to survive exposure to 16000 microg/mL tobramycin, a concentration commonly found inside the atomization chamber of nebulizers used to deliver aerosolized therapy, was studied. Under a variety of different growth conditions, all five strains were able to survive exposure to 16000 microg/mL of tobramycin. Post-exposure recovery was enhanced at 20 degrees C and 30 degrees C in comparison with 37 degrees C under all test conditions. The importance of these findings in relation to the epidemiology of S. maltophilia in patients with cystic fibrosis is discussed.

Administration, Inhalation↗
PubMed2001

Susceptibility of Burkholderia cepacia and other pathogens of importance in cystic fibrosis to u.v. light.

To investigate the potential usefulness of u.v. germicidal irradiation (UVGI) in preventing the spread of Burkholderia cepacia, an important pathogen in cystic fibrosis (CF), the in-vitro susceptibility of B. cepacia to UVGI was determined. Five strains were exposed to UVGI from a 7.2-W source. Burkholderia cepacia was less susceptible to UVGI than other important CF-related pathogens, namely Staphylococcus aureus and Pseudomonas aeruginosa, but was more susceptible than Stenotrophomonas maltophilia. No strain of B. cepacia survived longer than an 8 s exposure to UVGI, with doses required to achieve 1 log reduction in bacterial numbers ranging from 28.3 to 57.5 J m(-2).

Burkholderia Infections↗
PubMed2000

Survival and growth of Burkholderia cepacia within the free-living amoeba Acanthamoeba polyphaga.

The aim of this study was to investigate whether Burkholderia cepacia is capable of survival and growth within the free-living amoeba Acanthamoeba polyphaga using a differential immunofluorescence assay of bacterial-amoebal cocultures and viable counts of bacteria determined after amoebal lysis. The numbers of intra-amoebal bacteria and the numbers of infected amoebae increased over time; although, when heat-killed bacteria were used, no intracellular bacteria were observed. These findings should be taken into account in future studies of environmental reservoirs of Burkholderia cepacia.

Acanthamoeba↗