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Biomedical subjects

L J Strausbaugh

Publications and source records attributed to L J Strausbaugh.

At least 37 records · Page 2Linked to original sources
PubMed1995

Vertebral osteomyelitis. How to differentiate it from other causes of back and neck pain.

Vertebral osteomyelitis, an uncommon infection, usually presents with the very common symptom of neck or back pain. Awareness of this disorder and its distinctive features aids physicians in prompt ordering of appropriate imaging studies, which usually lead to the diagnosis. Early diagnosis, identification of the infecting microbe, and appropriate antimicrobial therapy are the keys to preventing complications and reducing the need for surgical intervention.

Back Pain↗
PubMed1994

High frequency of yeast carriage on hands of hospital personnel.

The hands of 36 nurses and 21 nonnursing hospital employees were tested by culture with a modification of the broth wash technique. Seventy-five percent of the nurses and 81% of the nonnurses were found to harbor yeasts on their hands; 58% of nurses and 38% of nonnurses were carrying Candida spp.

Adult↗
PubMed1993

Toxic shock syndrome. Are you recognizing its changing presentations?

Nonmenstrual cases of toxic shock syndrome now occur at least as often as the classic menstrual cases. The syndrome has been reported in every conceivable clinical setting involving colonization or infection with Staphylococcus aureus and as a complication of surgical procedures, traumatic injuries, and local infections. Unusual clinical manifestations have been observed in patients with AIDS. Cases of toxic shock syndrome also have been linked to infection with toxin-producing strains of coagulase-negative staphylococci and group A streptococci. Knowledge of the expanding spectrum of toxic shock syndrome and early consideration of the disease in patients with fever, hypotension, rash, and/or multisystem disease are essential for timely diagnosis and optimum management.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Sensitivity of surveillance cultures for the detection of methicillin-resistant Staphylococcus aureus in a nursing-home-care unit.

This study compared the sensitivity of nasal culture alone versus multiple-site cultures and single versus duplicate sampling for the detection of methicillin-resistant Staphylococcus aureus (MRSA)-colonized individuals in a nursing-home population. Repeat culture of 68 specimens collected from 35 colonized subjects yielded identical results for 57 specimens, (84%), and 89% of the colonized residents (31 of 35) were identified by the first culture of multiple sites. A single nares culture detected 27 (77%) of 35 (first screen) and 29 (83%) of 35 (second screen) residents colonized with MRSA at any site. The most cost-effective screening would consist of a nasal culture only or combined with a gastrostomy tube site, if applicable. To identify all colonized individuals, however, it would be necessary to culture more than one specimen from multiple sites on each resident.

Aged↗
PubMed1993

Methicillin-resistant Staphylococcus aureus in a nursing home and affiliated hospital: a four-year perspective.

OBJECTIVES: To determine the effect of a methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a nursing home on the subsequent MRSA caseload in a closely affiliated hospital. DESIGN: Observational and descriptive; routine and special MRSA surveillance data for nursing home and hospital were reviewed for a four-year period (1988 to 1991) as were records regarding patient transfers from nursing home to hospital. SETTING: The 120-bed nursing home care unit (NHCU) and the geographically separate 434-bed acute care facility (hospital) of the Portland Veterans' Affairs Medical Center (PVAMC). PATIENTS: Veterans hospitalized in the acute care division of NHCU. RESULTS: Following the introduction of MRSA into the NHCU in December 1987, it quickly disseminated. Two to 32 newly colonized or infected patients were recognized in each quarter of the study period. Facility-wide prevalence surveys on two occasions disclosed MRSA colonization rates of 34% and 10%. During the study period, 15 to 54 (mean: 37.6) patients were transferred each quarter from the NHCU to the hospital of the PVAMC. The number of MRSA cases transferred ranged from 0 to 16 per quarter (mean: 5.4). During the same period, the total number of MRSA cases in the hospital increased, rising from 7 cases in 1987 to 16 in 1988, 48 in 1989, 34 in 1990, and 35 in 1991. The percentage of hospital MRSA cases accounted for by NHCU transfers was 0% in 1988, 38% in 1989, 12% in 1990, and 11% in 1991. CONCLUSIONS: Despite the steady flow of patients between the NHCU and the hospital, the MRSA outbreak in the NHCU was associated with only a modest increase in the MRSA caseload at the affiliated hospital.

Colony Count, Microbial↗
PubMed1992

Antimicrobial therapy for methicillin-resistant Staphylococcus aureus colonization in residents and staff of a Veterans Affairs nursing home care unit.

OBJECTIVE: To evaluate the effect of antimicrobial therapy on patients and staff colonized with methicillin-resistant Staphylococcus aureus (MRSA) in a skilled nursing facility and to assess the role of the environment as a potential reservoir for MRSA in the nursing home setting. DESIGN: As part of a comprehensive program to control an MRSA outbreak in a nursing home, patients and staff colonized with MRSA received 1 of 3 antimicrobial decolonization regimens depending upon the site and extent of colonization. Followup cultures were performed during therapy and on days 2, 7, 14, and 30 following the completion of therapy. Cultures of the patients' inanimate environment (pajamas, sheet, and floor) were obtained during and after therapy. Antimicrobial susceptibility tests were performed on 54 MRSA isolates obtained before and 44 MRSA isolates recovered after therapy. SETTING: A 120-bed Veterans Affairs nursing home care unit. PARTICIPANTS: Thirty-six patients and 7 staff nurses colonized with MRSA at 1 or more sites. INTERVENTION: Decolonization therapy with rifampin, trimethoprim-sulfamethoxazole, and clindamycin used alone or in various combinations for 5 or 10 days in conjunction with other infection control measures employed to combat the MRSA outbreak. RESULTS: Twenty (56%) of the 36 NHCU patients were either persistently colonized or became recolonized with MRSA during the 30-day followup period. Positive cultures on day 3 during therapy frequently identified patients who subsequently exhibited persistent or recurrent colonization. Before therapy, 92% of MRSA isolates were susceptible to rifampin, whereas only 43% of the isolates obtained after therapy were susceptible. Sixteen (80%) of 20 patients with persistent or recurrent colonization had rifampin-resistant strains of MRSA isolated after therapy. Twenty-three (18%) of 125 environmental cultures obtained during and after therapy from patients who exhibited persistent or recurrent colonization were positive for MRSA, in contrast to 9 (8%) of 107 from patients who were successfully decolonized. CONCLUSIONS: The decolonization component of the outbreak control program was judged to be ineffective and potentially hazardous because colonization persisted or recurred in more than half of the patients, and substantial antimicrobial resistance was noted in MRSA stains isolated after therapy. Resistance, especially to rifampin, and possibly re-acquisition of MRSA from other human or environmental sources were 2 factors that appeared to impede the decolonization effort.

Aged↗
PubMed1991

Methicillin-resistant Staphylococcus aureus in extended-care facilities: experiences in a Veterans' Affairs nursing home and a review of the literature.

OBJECTIVES: To delineate the spread of methicillin-resistant Staphylococcus aureus (MRSA) in a nursing home care unit (NHCU), determine its consequences, and discuss this experience in the context of reports from other nursing homes. DESIGN: Observational and descriptive; routine and special surveillance for MRSA, including a facility-wide prevalence survey; characterization of MRSA isolates by disk diffusion and agar dilution susceptibility studies and restriction enzyme analysis of plasmid (REAP) DNA. SETTING AND PATIENTS: A 120-bed skilled nursing facility that is an integral part of the Veterans' Affairs Medical Center (VAMC), Portland, Oregon. The patients are predominantly elderly men with severe underlying diseases and functional impairments. RESULTS: An asymptomatic carrier brought MRSA into the NHCU in December 1987. During the next 15 months, 24 additional MRSA cases were detected. A prevalence survey conducted in March 1989 indicated that 39 (34%) of the 114 patients and 8 (7%) of the 117 employees were colonized or infected with MRSA. All strains were resistant to ciprofloxacin. REAP DNA indicated that 37 of 41 strains recovered in the March survey had identical patterns. Although 16 episodes of MRSA infection occurred in NHCU residents during 1988 through 1989, the outbreak had little effect on overall patterns of infectious morbidity and mortality in the facility. The outbreak, however, did result in an increased MRSA caseload at the medical center's acute-care division. CONCLUSIONS: During the last three years, MRSA colonization and infection have become common in the NHCU at the Portland VAMC; this experience parallels that reported by several nursing homes in other parts of the country.

Disease Outbreaks↗
PubMed1990

Incidence and impact of infection in a nursing home care unit.

In this study we examined the frequency of infection and its consequences in a Veterans Administration medical center nursing home care unit during its first 9 months of operation. A total of 231 patients were enrolled and were followed up for an average stay of 115 days. Sixty-nine infections occurred in 50 patients and yielded a period prevalence rate of 22% and an infection incidence rate of 2.6 infections per 1000 days of patient care. Symptomatic urinary tract infections, pneumonia, and skin and soft tissue infections accounted for 41%, 32%, and 17% of the infections, respectively. Staphylococci, streptococci, and aerobic gram-negative bacilli were the most common bacterial isolates. Thirty-four episodes of infection (49%) required administration of parenteral antibiotics in the nursing home care unit, and 21 episodes (30%) necessitated transfer to the acute care hospital for management. Infection caused one death and contributed to the death of 4 of the 55 other patients who died during the study period.

Adult↗
PubMed1987

Intracarotid infusions of protamine sulfate disrupt the blood-brain barrier of rabbits.

This study examined the effect of intracarotid infusions of protamine sulfate on the blood-brain barrier of the rabbit. Evans blue, which binds tightly to serum albumin, served as the marker for blood-brain barrier disruption. Brains from 12 of 14 rabbits receiving 30-50 mg of protamine sulfate in an intracarotid infusion over 3 min demonstrated intense Evans blue-albumin staining in the distribution of the infused internal carotid artery. In contrast, brains from 5 animals receiving 0.9% saline and from 5 animals receiving 50 mg of protamine sulfate by the intravenous route showed no evidence of blood-brain barrier disruption. Premixing protamine sulfate with heparin prior to intracarotid administration greatly reduced or abolished Evans blue staining of the brain as did delayed administration of the marker dye. Thus, the interaction of the positively charged protamine molecule with the vascular endothelium of cerebral capillaries transiently alters the permeability of the blood-brain barrier in the rabbit.

Animals↗
PubMed1987

Hematologic manifestations of bacterial and fungal infections.

Bacterial and fungal infections have a varied and often profound effect on the cellular elements of the blood and the hemostatic system. These infections may increase or decrease numbers of circulating erythrocytes, leukocytes, and platelets or may induce qualitative changes in these elements, some of which affect their function. Bacterial and fungal infections may also produce thrombosis or hemorrhage. They exert these effects through mechanisms that involve specific microbial virulence factors or host defenses mobilized against the infectious agents. This article focuses on the diverse hematologic manifestations of bacterial and fungal infections in the context of these mechanistic considerations.

Bacterial Infections↗
PubMed1986

Penetration of aztreonam into cerebrospinal fluid and brain of noninfected rabbits and rabbits with experimental meningitis caused by Pseudomonas aeruginosa.

This study examined the penetration of aztreonam into the cerebrospinal fluid (CSF) and brain in noninfected rabbits and rabbits with experimental meningitis caused by Pseudomonas aeruginosa. Animals received either 600 or 1,200 mg of aztreonam administered intravenously over 6 h. Aztreonam did not readily enter the CSF in the absence of meningitis. In noninfected animals, mean concentrations in the CSF ranged from 1.1 to 3.0 micrograms/ml with the 600-mg dose and from 2.3 to 4.7 micrograms/ml with the 1,200-mg dose. In contrast, mean concentrations of aztreonam in the CSF were significantly higher (P less than 0.01) at each sampling time in rabbits with experimental meningitis caused by P. aeruginosa. They ranged from 10.2 to 14.6 micrograms/ml with the 600-mg dose and from 29 to 40 micrograms/ml with the 1,200-mg dose. Although concentrations in the brain measured at 6 h tended to be higher in infected rabbits, this difference was not statistically significant. Aztreonam therapy produced a substantial decline in CSF bacterium counts over 6 h: mean CSF counts decreased 2.4 log10 CFU/ml in the 600-mg dose group and 3.0 log10 CFU/ml in the 1,200-mg dose group. The results of this study suggest that aztreonam may be useful in the therapy of meningitis caused by P. aeruginosa.

Animals↗
PubMed1985

Staphylococcus epidermidis arthritis following catheter-induced bacteremia in a neutropenic patient.

Sepsis due to methicillin-resistant Staphylococcus epidermidis occurred in a neutropenic man during management with a Hickman-Broviac catheter. Despite catheter removal and 10 days of i.v. cefazolin therapy, he developed septic arthritis 6 weeks later in a nonprosthetic hip joint. S. epidermidis was isolated from the joint and found to have plasmid and phage susceptibility patterns identical to the previous blood isolate. This case is the first to document a metastatic infection from catheter-associated S. epidermidis bacteremia. It suggests that cephalosporins may not be optimal in such infections despite in vitro sensitivity. Vancomycin appears to be the drug of choice for S. epidermidis bacteremia in the neutropenic population.

Adult↗
PubMed1983

Effect of osmotic blood-brain barrier disruption on gentamicin penetration into the cerebrospinal fluid and brains of normal rabbits.

Rapid infusion of hyperosmolar solutions into the internal carotid artery transiently disrupts the blood-brain barrier, permitting entry of substances that are ordinarily excluded from the nervous system. This study compared gentamicin concentrations in the cerebrospinal fluid (CSF) and brain tissue of rabbits receiving intracarotid infusions of 2 molal mannitol with those in three groups of control animals. After catheter placement and intravenous gentamicin administration (20 mg/kg), rabbits received either 2 molal mannitol in the internal carotid artery, 2 molal mannitol intravenously, 0.9% saline in the internal carotid artery, or 0.9% saline intravenously. Mannitol and saline were administered in 8-ml bolus injections over 40 s. After 2 h, serum, CSF, and brain specimens were obtained for antibiotic assay. Gentamicin concentrations in serum were comparable in all groups (mean concentrations ranged from 14.6 to 17.9 micrograms/ml at 60 min and from 5.7 to 7.4 micrograms/ml at 135 min), but gentamicin concentrations in CSF and brains were significantly higher in animals in the group receiving mannitol in the internal carotid artery. In this group the mean gentamicin concentration in CSF, 5.3 micrograms/ml, was twofold greater than those in the other three groups (range, 1.7 to 2.6 micrograms/ml). Similarly, the mean gentamicin concentration in the brains of animals in the group receiving mannitol in the internal carotid artery, 2.3 micrograms/g was significantly higher than those in the other groups (mean of measurable values, 1.4 micrograms/g, in all three control groups). Osmotic disruption of the blood-brain barrier enhanced the penetration of gentamicin into CSF and brain tissue.

Animals↗
PubMed1983

Effect of mannitol infusions into the internal carotid artery on entry of two antibiotics into the cerebrospinal fluid and brains of normal rabbits.

The rapid infusion of hyperosmolar solutions into the internal carotid artery transiently disrupts the integrity of the blood-brain barrier, permitting entry of substances normally excluded from the nervous system. This study examined the effect of such an infusion on the penetration of vancomycin and tobramycin into the cerebrospinal fluid and brains of normal rabbits. Groups of five to seven animals were assigned either to control groups, receiving vancomycin or tobramycin alone, or to experimental groups, receiving these antibiotics with 40-s intracarotid infusions of 8.0 ml of 25% mannitol. Serum, cerebrospinal fluid, and brain specimens were obtained for assay 135 min after dosage. Concentrations of these antibiotics in serum were comparable in control and experimental groups; concentrations of the antibiotics in cerebrospinal fluid were significantly higher in the experimental groups. Mean (+/- standard deviation) concentrations of the antibiotics in cerebrospinal fluid were, respectively, less than 0.5 and 4.1 +/- 4.6 micrograms of vancomycin per ml and 0.6 +/- 0.5 and 3.4 +/- 2.4 micrograms of tobramycin per ml in the control and experimental groups. The concentrations of these antibiotics in brains were also higher in the experimental groups. This trend achieved statistical significance in the tobramycin studies, where control animals uniformly had tobramycin concentrations in brains of less than 0.1 microgram/g and experimental group animals had a mean concentration of 0.4 microgram/g. Additional studies with tobramycin indicated that intracarotid antibiotic administration immediately after the mannitol infusion further augmented antibiotic concentrations in brains.

Animals↗