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Biomedical subjects

L O Gentry

Publications and source records attributed to L O Gentry.

At least 55 records · Page 3Linked to original sources
PubMed1989

New approaches to the diagnosis and treatment of infective endocarditis: review of 100 consecutive cases.

To assess the effect of our new, more aggressive approach to treating infective endocarditis, we retrospectively reviewed our recent experience with this disease. Between 1983 and 1989, we treated 100 patients with endocarditis, in 94 of whom the diagnosis was confirmed. Fifty-four (57%) of the 94 patients had native valve endocarditis, and the other 40 patients (43%) had prosthetic valve endocarditis. The patients' mean ages were 50 years for native valve disease and 58 years for prosthetic valve disease (p < 0.05). The male-to-female ratio was 4:1. Among the patients with confirmed endocarditis, 87 (93%) had significant underlying risk factors for endocarditis. Upon physical examination of the 94 patients, 16 (17%) were afebrile, 15 (16%) had negative blood cultures, and 26 (28%) had no cardiovascular symptoms or immunologic findings. Echocardiography was of limited value: its sensitivity was 56% for native valve endocarditis and 33% for prosthetic valve endocarditis. The ratio of affected valves was 5 aortic:4 mitral: 1 tricuspid in both forms of the disease. Viridans streptococcus was isolated in 23 (25%) of the confirmed cases, Enterococcus faecalis in 17 (18%), Staphylococcus aureus in 13 (14%), and coagulase-negative staphylococcus in 14 (15%). Gram-negative, anaerobic, and fungal organisms accounted for only 13 (14%) of the confirmed cases. The mean duration of intravenous therapy was 29 days. Twenty (37%) of the native valve patients and 16 (40%) of the prosthetic valve patients received antibiotics on an outpatient basis. Vancomycin was used in 44 (47%) of the cases, nafcillin or ampicillin in 40 (44%), and other beta-lactam agents in 9 (10%). The mean hospital stay was significantly longer for prosthetic valve endocarditis patients than for those with native valve disease (29 versus 23 days; p < 0.01). Cardiac catheterization was performed in 9 native valve patients (17%) and 6 prosthetic valve patients (15%). Valve surgery was performed in 33 native valve patients (61%) and 22 prosthetic valve patients (55%). Failure, defined as in-hospital death or recurrent endocarditis, accounted for 14 (28%) of the native valve cases (17% death and 11% relapse) and 8 (20%) of the prosthetic valve cases (10% death and 10% relapse), for an overall failure rate of 24%. The rate of failure was independent of the infecting pathogen or the type of antimicrobial therapy applied. Our experience verified that, in many patients with significant underlying risk factors, the diagnosis of endocarditis may be made on an empiric basis.

Journal Article↗
PubMed1989

Suction lipoplasty: biohazardous aerosols and exhaust mist--the clouded issue.

With the increased popularity of suction lipoplasty procedures, attention has been focused on their safety. One significant concern involves the rotary vane aspirators used to provide the suction required for the procedure. A series of experiments was carried out to determine whether aerosols are produced during the use of a rotary vane aspirator, since aerosols are known to be hazardous under appropriate conditions. Using a viable strain of Pseudomonas aeruginosa, we challenged the system through the suction port, and the exhaust from the aspirator was then cultured in a particle sampler. Results indicate that viable pathogens are released from the exhaust in physiologically significant particles capable of penetrating to the level of the alveolus in the normal human lung. These infectious particles were produced for 3 hours after the initial challenge. When an appropriate filtration device was attached to the aspirator outflow, the aspirator pump and environment were protected. In the absence of an appropriate filtration device, the aerosolized particles may constitute a hazard to patients or medical workers in the vicinity of the aspirator.

Aerosols↗
PubMed1989

Oral ciprofloxacin vs parenteral cefotaxime in the treatment of difficult skin and skin structure infections. A multicenter trial.

A prospective, randomized, double-blind, multicenter study was conducted of hospitalized patients to compare the efficacy and safety of oral ciprofloxacin (dosage, 750 mg every 12 hours) with intravenous cefotaxime (dosage, 2.0 g every 8 hours) as monotherapy for difficult skin and skin structure infections requiring hospitalization. Five hundred seventy patients were assessed for an analysis of safety and 461 patients were assessed for an analysis of efficacy. The most common infections were infected ulcers and abscesses. At the end of therapy, there was a higher incidence of recurrent or persistent organisms in the cefotaxime group compared with ciprofloxacin. Adverse reactions related to either therapy were rare. By pathogens, there were no differences in activity, except the higher rate of recurrent or persistent Pseudomonas aeruginosa infection in the cefotaxime group. By diagnosis, the two drugs had comparable efficacy, except for the higher incidence of bacteriologic failure in patients with polymicrobial infected ulcers in the cefotaxime group. Larger studies are needed to evaluate emergence of resistance to ciprofloxacin. Oral ciprofloxacin therapy is as safe and effective as parenteral cefotaxime in the treatment of difficult infections of the skin and skin structure, and affords the prospect of early discharge from the hospital and significant cost savings.

Administration, Oral↗
PubMed1988

Evaluation of roxithromycin (RU-965) versus cephradine in pneumococcal pneumonia.

One hundred and sixty black South African gold miners with acute pneumococcal pneumonia were enrolled in a prospective randomized double-blind trial comparing roxithromycin (150 mg 2 X day) with cephradine (1.0 g 2 X day). Ninety patients with pneumonia caused by Streptococcus pneumoniae were treated for 5-10 days. Forty-three of 46 (93.4%) of the roxithromycin and all 44 (100%) of the cephradine treated groups had satisfactory clinical responses. In eight of the 46 (17%) roxithromycin treated patients and 10 of the 44 (23%) cephradine treated patients, Streptococcus pneumoniae was not eradicated from sputum cultures by the tenth day. Side effects in 18 patients (20%) were mild and were usually manifested by elevation of the transaminases; these were more common in the cephradine group (12) than in the roxithromycin group (5). Roxithromycin appears to be a safe and effective oral antibiotic for treatment of patients with mild to moderate pneumococcal pneumonia.

Adult↗
PubMed1988

Results of noncomparative studies of cefotetan in the treatment of obstetric and gynecologic infections.

In a multicenter trial involving 11 centers, 160 women were enrolled to evaluate the safety and effectiveness of 1 or 2 gm of cefotetan administered every 12 hours in the treatment of obstetric and gynecologic infections. The 133 evaluable patients generally were under 25 years of age, were nonwhite, and had hospital-acquired endometritis or pelvic inflammatory disease caused by both aerobic and anaerobic bacteria. Escherichia coli, Neisseria gonorrhoeae, group D streptococci, Bacteroides sp., and Peptococcus sp. were among the most frequently isolated pathogens. The patients were treated for a mean of 5.6 +/- 1.6 days and received a total dose of 19.27 gm. The signs and symptoms of infection were cleared or improved in 93% of the 133 patients evaluable for clinical response. Of the 116 evaluated bacteriologically, 95% had a satisfactory or presumed satisfactory response; only six patients (5%) were considered to be bacteriologic failures. Differences in the results of several clinical laboratory tests performed before and after treatment were statistically, but not clinically, significant (p less than 0.05). Safety was evaluated in the 158 patients who received cefotetan, and only four (3%) had adverse reactions considered related to the drug. Cefotetan was clearly effective and produced no untoward reactions in these women with obstetric and gynecologic infections caused by both aerobic and anaerobic organisms when administered at 1 or 2 gm every 12 hours.

Adult↗
PubMed1988

Antibiotic prophylaxis in open-heart surgery: a comparison of cefamandole, cefuroxime, and cefazolin.

We undertook a prospective randomized evaluation of cefamandole nafate, cefuroxime sodium, and cefazolin sodium as prophylaxis in open-heart operations. A total of 903 patients having an elective procedure were enrolled in the study, and 620 of them were eventually considered evaluable. There were no significant differences between the three study groups. The overall rate of infection and the rate of infection according to demographic variables was not significantly different between the three antibiotics. Serious complications and deaths were also similar between the three agents. The presence of multiple severe underlying conditions was a risk factor for infection, independent of the antibiotic used. We conclude that there are no differences in the efficacies of the three agents in preventing postoperative infections in patients having open-heart operation. Cefuroxime, principally because of its every-12-hour dose, is far less expensive than cefamandole or cefazolin.

Cardiac Surgical Procedures↗
PubMed1988

Osteomyelitis: options for diagnosis and management.

The bacterial aetiology of osteomyelitis is best determined by bone biopsy under radiographic control. While Staphylococcus aureus is still the most common cause of osteomyelitis, Gram-negative bacteria occur more frequently than they did in the past. The prognosis of antibiotic treatment is made worse by chronic infection and by underlying conditions, such as diabetes mellitus or peripheral vascular disease. Treatment for six weeks with single broad-spectrum antimicrobial agents can give success rates similar to those obtained with combination therapy, including aminoglycosides, and with less toxicity. Newer diagnostic methods (radionuclide scans and radiographic techniques) and treatment options (antibiotic-containing acrylic beads and microvascular grafts) may offer improved management if used discriminatingly.

Humans↗
PubMed1987

Roxithromycin, a new macrolide antibiotic, in the treatment of infections in the lower respiratory tract: an overview.

Roxithromycin is a new macrolide antibiotic with good absorption and a longer half-life than erythromycin. Worldwide clinical studies to evaluate its efficacy and safety in the treatment of infections of the lower respiratory tract have achieved a clinical success rate of 89% with few and mild side effects. Double-blind studies comparing roxithromycin with cephradine, erythromycin ethylsuccinate and doxycycline in pneumonia, acute exacerbations of bronchitis in patients with chronic obstructive airways disease, and acute bronchitis have been done. The clinical response to comparative regimens has been similar and ranges from 60% response with either regimen in patients with chronic airways disease to 90% response in patients with acute bronchitis or pneumonia. Roxithromycin appears to be as effective as erythromycin or doxycycline for the treatment of either Streptococcus pneumoniae or Haemophilus influenzae infections. A large double-blind trial comparing cephradine and roxithromycin in 90 cases of bacteriologically confirmed pneumococcal pneumonia in South African gold miners resulted in a 93% and 100% respective clinical response rate. The bacteriological results revealed interesting results in this same study, in that cultures from 17% of patients receiving roxithromycin and 23% of those receiving cephradine remained positive for S. pneumoniae after therapy was finished and an excellent clinical response had been obtained. Side effects in all studies have been transient and mild, with an elevated transaminase value being the most common in both roxithromycin and erythromycin or cephradine regimens. Roxithromycin appears to be a safe and effective oral antibiotic for the treatment of pneumococcal pneumonia and other infections of the lower respiratory tract, and is as effective as erythromycin, doxycycline or cephradine.

Humans↗
PubMed1987

Cephalosporins in urinary tract infection.

Despite their greater cost compared with other antibiotics, the cephalosporins continue to be used in the treatment of urinary tract infections. Most cephalosporins are excreted primarily by the kidney (by glomerular filtration, tubular secretion, or both) and urinary concentrations routinely exceed 1000 mg/L after even a small dose; exceptions include cefoperazone and ceftriaxone which both exhibit significant biliary excretion, and in patients with significant renal dysfunction only minimal concentrations of these drugs may be present in the urine. Although single-dose treatment of uncomplicated lower urinary tract infections with oral cephalosporins has not been as effective as with other antibiotics, cephalexin, cephradine and cefaclor continue to be used. Early clinical trials with cefuroxime axetil also appear promising for short term and single-dose therapy. The parenteral cephalosporins are reserved for use against more resistant strains or in hospitalised patients with upper urinary tract infections, their choice being directed by in vitro susceptibility tests. Newer agents such as ceftazidime and cefsulodin have been shown to be effective in infections due to P. aeruginosa. Recommended cephalosporin dosage regimens for the common urinary tract pathogens are given.

Cephalosporins↗
PubMed1987

Cefamandole prophylaxis for cardiovascular surgery: a dosage comparison.

For more than a decade, studies have indicated that antibiotic dosing immediately before and for a short time after surgery is effective in reducing the incidence of infectious complications of open-heart operations. At our institution we have used cefamandole, because of its broad spectrum of activity against bacteria common to the skin and respiratory system and its low toxicity. However, in response to more recent studies that threw doubt on the ability of the recommended dosing regimen (1.0 g given intravenously every six hours for three days) to maintain adequate intraoperative levels of cefamandole in heart tissue, we undertook an evaluation of a dosage of 2.0 g given intravenously every 6 hours for two days. This was a randomized study of 211 successive, evaluable, open-heart surgery patients who had no concurrent infections or cephalosporin allergy. Postoperatively, there were eight surgery-related infections (3.9%) and eight nosocomial infections in the 2.0-g dose group, compared with seven surgery-related infections (3.5%) and seven nosocomial infections in the 1.0-g dose group. These differences were not statistically significant. Tissue levels and cardiopulmonary bypass pump time were not risk factors for infection. We conclude that the 2.0-g doses over two days are no more effective than the 1.0-g doses over three days. However, when administration fees are considered, in a cost comparison, the 2.0-g dosing regimen is more economical than the 1.0-g regimen.

Journal Article↗
PubMed1987

Management of infection in the post-cardiac-transplant patient.

In reviewing our post-transplant experience with infection in 192 cardiac transplant patients, we have noticed a pattern. During the first month following transplantation, the patient seldom has an opportunistic infection, but is in danger of nosocomial infection (84 episodes in 57 patients). These include wound infection, and infections of the lungs, blood, and urinary tract. After the first month, and for the duration of the first year following transplantation, nosocomial infections become less common and opportunistic infections dominate (176 episodes in 111 patients). Although viruses are the most common opportunistic pathogens (100 infections in 111 patients), bacteria, fungi, and parasites are the most serious threats, especially when they affect the lungs. We relate our experience in prophylaxis, diagnosis, and treatment throughout the first year following transplant.

Journal Article↗
PubMed1987

Overview of osteomyelitis.

Osteomyelitis is becoming a more common infection. This increase has been associated with an increase in the number of orthopaedic surgical procedures and with severe bone trauma. The etiology of osteomyelitis is also changing, with more gram-negative and more polymicrobial infections due to both gram-positive and gram-negative pathogens. Underlying diseases such as diabetes mellitus, peripheral vascular and sickle cell disease are associated with a poor cure rate when treated with antibiotics. The emergence of resistant strains of bacteria during the long-term treatment necessary for osteomyelitis has been documented, and continues to be a concern, as are the other side effects.

Adult↗
PubMed1986

Incidence and significance of candida antigen in low-risk and high-risk patient populations.

A latex agglutination test which detects candida antigen in patients with disseminated infection was used to screen 328 patients. Of these patients 100 had renal failure but no signs or symptoms of candida infection, and 100 had high rheumatoid factor titers but also no signs or symptoms of candida infection. The remaining 128 patients were considered at high risk of developing systemic candida infection. Sequential titers were also determined in a number of these patients. The incidence of candida antigen titers greater than or equal to 1:4 in the low-risk population was 3% as compared to 53% in the high-risk group. None of the patients with positive rheumatoid factor titers had candida antigen titers greater than or equal to 1:2, however 13% had nonspecific agglutination at titers greater than 1:2. The incidence of nonspecific agglutination increased with increasing rheumatoid factor titers. In general the candida antigen titers correlated well with clinical findings and with the course of infection in those patients in whom sequential candida antigen titers were determined. This latex test thus appears to be a useful adjunct procedure for the diagnosis of serious candida infections.

Antigens, Fungal↗
PubMed1986

Single agent cephalosporin prophylaxis for penetrating abdominal trauma. Results and comment on the emergence of the enterococcus.

Multiple studies have shown that the incidence of infectious complications after penetrating abdominal wounds are decreased by the perioperative administration of antibiotics. In this study of three separate single cephalosporin agents (cefotaxime, cefoxitin, and moxalactam) given for a 48 hour period in patients who sustained perforating gastrointestinal wounds, uncomplicated recoveries occurred in 93 percent of all patients. The rates of uncomplicated recovery were significantly different for the three groups; however, patients with major intraabdominal vascular injuries were more common in the cefoxitin-treated group. One disturbing feature was the presence of enterococci in 57 percent of isolates from wound infections and 60 percent of isolates from intraabdominal abscesses. Enterococci as sole isolates were found in one of two wound infections and three of four intraabdominal abscesses in the moxalactam-treated group.

Abdominal Injuries↗
PubMed1986

Diagnosis and treatment of infection in cardiac transplant patients.

Despite major advances in the management of rejection and the development of newer and more potent antimicrobials, infection still constitutes a major problem in transplant patients and other immunosuppressed hosts. Infectious complications in transplant patients clearly occur in two phases. The first phase includes the first 30 to 60 days after transplantation. During this period, nosocomial bacterial infections are most commonly encountered. Pulmonary, renal, and wound infections have all been encountered, and prophylactic antibiotics appear to decrease their frequency. Opportunistic infections usually do not occur during this period unless the patient undergoes treatment for acute rejection. The second phase of infectious complications usually follows the first month after transplantation. In this period, the level of immunosuppression is high, and opportunistic infections are common. Opportunistic pulmonary infections caused by P. carinii, L. pneumophila, cytomegalovirus, Aspergillus, and Nocardia spp. all are potentially life-threatening complications to the transplant patient. Aggressive diagnostic tests such as bronchoscopy, percutaneous needle biopsy, or open lung biopsy are frequently needed to make a diagnosis. Empiric broad-spectrum antimicrobial therapy is indicated in the ill patient; however, more specific therapy should be instituted once the diagnosis is confirmed.

Anti-Bacterial Agents↗
PubMed1986

Treatment of acute pelvic inflammatory disease with aztreonam, a new monocyclic beta-lactam antibiotic, and clindamycin.

Forty-two patients with acute pelvic inflammatory disease were treated using aztreonam, a monobactam, and clindamycin. Sixty-four percent of protocol patients were culture positive for Neisseria gonorrhoeae, and 26% had positive endometrial cultures for other organisms. Fifty-one percent of patients had ultrasound findings consistent with a pelvic abscess. One patient with a tuboovarian abscess palpable to the umbilicus became afebrile and improved on treatment, but ultimately was treated surgically. All other protocol patients responded rapidly to the aztreonam-clindamycin regime, giving a 97.7% cure rate.

Adult↗