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Biomedical subjects

L G Burman

Publications and source records attributed to L G Burman.

At least 73 records · Page 4Linked to original sources
PubMed1991

Epidemiology of enteric bacteria in neonatal units--influence of procedures and patient variables.

Among 953 infants in 22 neonatal care units studied, 23% (median value, range 0-78) were found to be faecally colonized with one of 21 distinct nosocomial strains of Escherichia coli, Klebsiella or Enterobacter spp. Lower birth weight was associated with such colonization, particularly with nosocomial phenotypes of E. coli. Caesarean section followed by prolonged incubator care, and hospital stay, were additional factors associated with colonization by such strains of E. coli. Antibiotic therapy of the infant and type of feeding were not found to be associated with acquisition of nosocomial strains of enteric bacteria among neonates.

Cesarean Section↗
PubMed1991

The use of the PhP-KE biochemical fingerprinting system in epidemiological studies of faecal Enterobacter cloacae strains from infants in Swedish neonatal wards.

The PhenePlate (PhP) biochemical fingerprinting system is an automated method for typing of bacteria, based on the evaluation of the kinetics of biochemical reactions, performed in microtitre plates. In the present study the PhP-Klebsiella/Enterobacter (KE) system was evaluated for typing of Enterobacter cloacae and employed to study the epidemiology of faecal E. cloacae strains isolated from infants in 22 Swedish neonatal wards. The PhP-KE system showed a high reproducibility and discrimination for E. cloacae isolates. Among 64 epidemiologically unrelated E. cloacae strains, 49 distinct phenotypes were found, and the diversity index was 0.985. E. cloacae was found as a part of the dominating Gram-negative aerobic bacterial flora in 83 out of 953 infants studied. The incidences of E. cloacae colonization varied between 0 and 35% in different wards, but in contrast to previous data for Klebsiella spp. and Escherichia coli, there was little evidence of spread of particular strains in the wards. We also discuss two different measures of nosocomial transmission of bacterial strains: transmissible strains and epidemic index.

Bacterial Typing Techniques↗
PubMed1991

Outbreak of group A streptococcal bacteremia in Sweden: an epidemiologic and clinical study.

The nationwide incidence of group A streptococcal bacteremia in Sweden was 1.8 per 100,000 population in 1987. During the winter season 1988-1989, the reported cases rate doubled and then declined to the previous level. The peak was due to a type T1/M1 Streptococcus pyogenes strain associated with an increased case fatality rate (33% vs. 15% for other T types). The highest incidence rates were found in the age groups less than 12 months and greater than 70 years. Among a sample of 79 patients hospitalized in November or December 1988, a portal of entry, mainly cutaneous, was recognized in 89% of the patients and concomitant conditions in 67%. Among the clinical findings were signs of skin or soft tissue infection (41%), local or generalized pain (41%), vomiting or diarrhea (24%), cough (18%), and upper respiratory tract symptoms (12%). A fatal outcome was associated with high age, lower respiratory tract or unknown focus, leukopenia on admission, start of antibiotic therapy greater than 6 h after the patient's initial contact with a physician, and a rapid clinical course including multiple organ failure. Renewed awareness of the many facets of fulminant streptococcal infection represents one approach to minimize the case fatality rate.

Disease Outbreaks↗
PubMed1991

Antibiotic susceptibility of 629 bacterial blood and CSF isolates from Swedish infants and the therapeutic implications.

Blood and CSF isolates (n = 629) from Swedish infants up to one year of age were tested in vitro against 13 antimicrobial agents in order to update the guidelines for empiric therapy of septicaemia and meningitis. Ampicillin plus gentamicin provided inadequate empiric therapy for meningitis, due to the poor CSF penetration of the aminoglycoside and the frequent occurrence of bacterial resistance to ampicillin. Ceftazidime and cefuroxime were moderately active, particularly against isolates from small infants. Cefotaxime today seemed to provide the best empiric therapy of septicaemia and meningitis in infants. Because of the occurrence of Listeria and enterococcal infections, ampicillin should initially be added and other combinations are also advisable for the occasional cases of Enterobacter, Citrobacter, Serratia, and Pseudomonas infections. For coagulase-negative staphylococci only vancomycin offered a broad activity (100% at achievable serum levels).

Aminoglycosides↗
PubMed1990

Drug-resistant coagulase-negative skin staphylococci. Evaluation of four marker systems and epidemiology in an orthopaedic ward.

Drug-resistant coagulase-negative staphylococci (DRCNS) in orthopaedic patients and ward staff were studied. A significant increase in the DRCNS carriage rate was observed among the 16 patients studied after 14 days of hospitalization with levels approaching that of the staff. Patients receiving dicloxacillin prophylaxis (n = 9) were more likely to be colonized with methicillin-resistant CNS, while patients receiving no antibiotics (n = 7) became to a larger extent colonized with multiple DRCNS. The combined data from species determination, biochemical, plasmid, and antibiogram typing revealed a considerable diversity among DRCNS; 64 types were distinguished among 112 DRCNS isolates selected for study after exclusion of apparently duplicate isolates. Plasmid plus antibiogram typing yielded almost as many types (61); whereas species determination plus antibiogram distinguished only 33 types. Although a novel computerized 96-reaction biotyping method alone enabled differentiation of 17 biotypes, most DRCNS isolates belonged to one of three major biotypes limiting the usefulness of this method. Ten of the 64 (16%) DRCNS types identified comprised 50 of the 112 (45%) isolates. These were isolated from staff and from patients on day 14, suggesting a nosocomial origin.

Adult↗
PubMed1990

Emergence of cross-resistance to beta-lactam antibiotics in fecal Escherichia coli and Klebsiella strains from neonates treated with ampicillin or cefuroxime.

Both ampicillin and cefuroxime therapy of neonates selected drug- and species-dependent beta-lactam resistance patterns in fecal strains of Escherichia coli and Klebsiella spp. This was in contrast to our previous findings that ampicillin, but not cefuroxime, contributed to the emergence of beta-lactam resistance also by the promotion of nosocomial spread of resistant strains.

Ampicillin↗
PubMed1990

Optimized urinary microscopy for assessment of bacteriuria in primary care.

Microscopy of wet-stained urinary sediment as an indicator of bacteriuria was evaluated in 418 consecutive primary care visits in a small community. Delivery of morning urine was encouraged and contributed to bladder incubation times of 4 or more hours in 79% of the visits; the overall culture positivity was about 80%. Bacteria or leukocytes alone or together as minimal requirements were suboptimal microscopy criteria for bacteriuria, whereas a minimum of moderate amounts of bacteria or 5 leukocytes per high-power field (x400) as a cutoff point yielded the best diagnostic accuracy. Optimization of urinary sediment microscopy in this way resulted in a desirable high sensitivity (97%) and efficacy (86%) in acutely symptomatic patients, as well as reasonably high efficacy (79%) in other patients, independent of sex or bladder incubation time. The method's simplicity and speed recommend it for use in primary care, particularly in patients with acute symptoms of urinary tract infection.

Bacteriuria↗
PubMed1990

The significance of timing of metronidazole prophylaxis and addition of fosfomycin in colorectal surgery. An experimental study in rats.

A novel approach to antibiotic prophylaxis in colonic surgery, suggested by our previous clinical experience, was experimentally tested. Intravenous administration of metronidazole or fosfomycin at greater than or equal to 4 hours before surgery effectively prevented lethal infectious complications, whereas metronidazole prophylaxis begun at induction of anaesthesia proved to be much less efficacious (4% and 43% deaths vs. 50% among controls, p less than 0.001 and p greater than 0.7, respectively). The in vivo efficacy of antibiotic prophylaxis correlated better with mucosal counts of Clostridium and Bacteroides than with luminal counts of aerobic or anaerobic bacteria. Earlier initiation of intravenous metronidazole prophylaxis thus markedly increased its in vivo efficacy, apparently due to preoperative mucosal suppression of endogenous potential pathogens. This 'early timing' approach to systemic prophylaxis against infection in abdominal surgery warrants further evaluation both for other antibiotics and clinically.

Animals↗
PubMed1989

Ecological impact of ampicillin and cefuroxime in neonatal units.

The relation between local antibiotic consumption and faecal carriage of beta-lactam-resistant strains of Escherichia coli and Klebsiella spp was studied in 953 children discharged from twenty-two neonatal units. An increased rate of carriers of Klebsiella spp strains resistant to ampicillin, cefuroxime, and cephalexin and of E coli strains resistant to ampicillin was associated with the use of ampicillin, with or without gentamicin. Ampicillin and cephalosporin (86% cefuroxime) consumptions were inversely related, which probably explained the paradox that cephalosporin use (and therefore less ampicillin use) was negatively correlated with the carriage of Klebsiella spp strains resistant to ampicillin, cefuroxime, and cephalexin. The ecological impact of antibiotics was much the same among treated and untreated babies in each unit. The findings show a greater risk of drug resistance due to a related agent rather than to the drug itself and a clear indirect impact of an antibotic on the microflora of untreated patients. Ampicillin-based regimens are more likely than cefuroxime to produce drug-resistant strains in the newborn.

Ampicillin↗
PubMed1989

A 7-year survey of drug resistance in aerobic and anaerobic fecal bacteria of surgical inpatients: clinical relevance and relation to local antibiotic consumption.

One-day studies of bacteriological cultures of fecal specimens obtained from 409 surgical inpatients at 5 occasions enabled rapid assessment of antibiotic resistance in aerobic and anaerobic bacteria, relevant to abdominal infection. This novel approach to surveillance of drug resistance was tested in a 7-year survey at a surgical department. A distinct correlation between local drug consumption and prevalence of resistant fecal bacteria was recorded for ampicillin and doxycycline. 17 other agents studied showed no such obvious correlations. Huge increases of cefuroxime and metronidazole consumption caused no emergence of drug resistant aerobic and anaerobic fecal bacteria. Imipenem was the only agent tested, which inhibited both the aerobic and anaerobic fecal bacteria of nearly all patients.

Abdomen↗
PubMed1989

Uricult and Sensicult dipslides for diagnosis of bacteriuria and prediction of drug resistance in primary health care.

Uricult dipslide as an indicator of bacteriuria yielded acceptable results in primary health care (PHC), and readings by local staffs were similar to those by laboratory technicians. Sensicult dipslide detected somewhat fewer bacteriurias and predicted bacterial drug sensitivity better than resistance (predictive values 93% and 50%, respectively). The mean risk of bacterial drug resistance against seven common urinary tract infection (UTI) antibiotics in PHC was 17%. The use of Sensicult for targeting UTI therapy resulted in an average risk of 7% for prescribing drugs to which the organism was resistant. The corresponding risk with Uricult for classification of UTI bacteria by Gram grouping, lactose and catalase reactions, and local guidelines for therapy of different bacterial groups, was also 7%. The latter method is simple, offers qualitative, and thus prognostic information, but can be further improved.

Bacteriuria↗
PubMed1988

Influence of age on faecal carriage of P-fimbriated Escherichia coli and other gram-negative bacteria in hospitalized neonates.

The aerobic faecal flora of 953 infants aged over 5 days was studied on discharge from 22 neonatal wards in Swedish hospitals. Klebsiella/enterobacter was isolated from 74% of infants and dominated the aerobic gram-negative flora in 19 wards. Escherichia coli was carried by 42% and showed a slight dominance in two wards. Initially klebsiella/enterobacter dominated the flora but became increasingly mixed with and taken over by E. coli, carriage increasing from 21% in infants discharged after 5-7 days to 57% after 3 weeks or later. Among infants with E. coli, P-fimbriated strains were demonstrated in 23% (range 0-67) and were independent of age. Occasional clustering of such strains was observed in 3/22 wards during the study period. It is postulated that the general and local colonization patterns observed reflect differences between individual strains of E. coli and klebsiella in both their capacity for transmission and their persistence in the newborn gut. The role of P-fimbriae in intestinal colonization of neonates by E. coli was, however, not supported.

Age Factors↗
PubMed1988

Influence of antibiotic therapy on faecal carriage of P-fimbriated Escherichia coli and other gram-negative bacteria in neonates.

The influence of previous antibiotic therapy on the aerobic faecal flora, including P-fimbriated Escherichia coli, was studied in 953 neonates at discharge from 22 neonatal wards in Sweden. Antibiotics, mainly ampicillin (with or without gentamicin) or cefuroxime, had been received by 37% of the infants. Treatment with ampicillin (with or without gentamicin) increased Klebsiella/Enterobacter and reduced Esch. coli colonization. Cephalosporin therapy (71% cefuroxime) reduced the frequency of colonization with both Esch. coli and Klebsiella/Enterobacter spp. but doubled the isolation rate of other Gram-negative bacteria (Citrobacter, Pseudomonas, Proteus and Acinetobacter spp.) and tripled the incidence of specimens yielding no aerobic Gram-negative growth. Gentamicin showed no significant ecological impact. The selection of Klebsiella/Enterobacter and P-negative Esch. coli strains by ampicillin was correlated with their resistance to this agent, while the association between P-fimbriated Esch. coli and cefuroxime therapy was not related to cefuroxime resistance.

Anti-Bacterial Agents↗