Biomedical subjects
M S Simberkoff
Publications and source records attributed to M S Simberkoff.
Amikacin therapy for serious gram-negative infection.
Amikacin sulfate was administered to 18 patients for the treatment of 19 severe infections. Seventeen infections were caused by gentamicin-resistant Gram-negative bacilli, and 13 patients were bacteremic. Bacteriologic cure was attained in all but one instance, and effective serum, bile, and pleural fluid drug levels were demonstrated. Drug-related fever occurred in one patient, and another experienced a maculopapular rash and monilial intertrigo. In three patients, reversible renal toxicity developed, but none had clinical evidence of ototoxicity. Amikacin sulfate in a dose of 15 mg/kg/day is an effective antibiotic for the treatment of serious Gram-negative infections, particularly those due to gentamicin-resistant organisms.
Recurrent urinary tract infection.
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Resistance of Staphylococcus aureus to semisynthetic penicillins and cephalothin.
Six strains of Staphylococcus aureus resistant to semisynthetic penicillins were recovered from clinical sources during a two-month period. Resistance was detected by standard disk sensitivity tests at 37 C. Two resistant strains were responsible for infections (one of which was fatal), and five strains were susceptible only to phage type 92. All of the strains produced penicillinase, which did not destroy oxacillin, and each was resistant to oxacillin at low inocula. Relative resistance to cephalosporin was demonstrable by the tube dilution assay but not by standard disk tests. The strains susceptible to phage type 92 were susceptible to vancomycin and to the synergistic action of oxacillin or cephalothin plus gentamicin.
Parenteral aminoglycoside antibiotics--1977. Clinical use.
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External otitis in diabetic.
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Urinary frequency in a diabetic.
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Urinary tract infection without significant bacteriuria.
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Mycoplasmemia in adult male patients.
Mycoplasma hominis mycoplasmemia was associated with obstruction, manipulation, or surgery of the genitourinary tract in five adult men. A four-fold increase in specific antibody titer against M hominis was demonstrated in serial convalescent serum obtained from one patient. Two patients became afebrile after treatment with tetracycline; a third recovered without therapy for a Mycoplasm infection. The two remaining patients died of thier underlying diseases.
Specific and Nonspecific immunity to Serratia marcescens infection.
By specific active or passive immunization, mice were protected against lethal infection with Serratia marcescens. Animals that were immunized against organisms of the challenge strain O serotype survived, whereas animals that were immunized against other serratia O serotypes did not survive. Protective sera (from convalescent partients or immunized rabbits) contained a specific complement-independent opsonin. These sera also contained passive hemagglutinating and bacterial agglutinating antibodies in high titer. The protective and complement-independent opsonizing antibodies were associated with IgG fractions of the serum, while the agglutinating antibodies were primarily associated with the IgM. Mice also survived infection with Serratia after immunization against the Re595 Salmonella minnesota mutant. However, complement-independent opsonizing antibody was not demonstrated in these cross-protective sera.
Bactericidal efficacy of Sch 20569 and amikacin against gentamicin-sensitive and -resistant organisms.
Sch 20569 is a semisynthetic derivative of gentamicin with activity against many gentamicin-resistant gram-negative bacilli. We compared its bactericidal action with that of gentamicin and amikacin against 171 clinical isolates of Enterobacteriaceae, Staphylococcus aureus, and Pseudomonas aeruginosa. Sch 20569 and amikacin showed markedly greater activity than gentamicin against Escherichia coli, Klebsiella, Enterobacter, Citrobacter, and indole-positive Proteus, primarily by virtue of their lethal effect on gentamicin-resistant strains (minimal bactericidal concentration >/= 12.5 mug/ml). Indole-negative Proteus isolates were uniformly sensitive to Sch 20569, whereas several were resistant to both gentamicin and amikacin. Amikacin was most active against Providencia, as was gentamicin against Serratia. All three agents exhibited similar activity against Pseudomonas. Staphylococcus aureus was more sensitive to gentamicin and Sch 20569 than to amikacin.
Host resistance to Serratia marcescens infection: serum bactericidal activity and phagocytosis by normal blood leukocytes.
Serratia marcescens strains isolated from clinical specimens can be divided into those which are sensitive or resistant to the bactericidal activity of normal human serum. Serum bactericidal activity is heat labile, cation dependent, and is absorbable by whole, serum-sensitive Serratia or ethanol-insoluble extracts of these organisms. Bacteremic Serratia infection is invariably caused by the serum-resistant strains. Serum resistant Serratia are ingested and killed by normal human leukocytes and fresh normal serum. Heating or preabsorption of serum with whole, heat-killed, or ethanol-insoluble antigen extracts of the serum-resistant Serratia diminishes opsonization and phagocytosis. Serratia opsonins in the serum of healthy individuals are type-specific IgM globulins which combine with the organism and activate complement by the alternate pathway.
Treatment of pulmonary infections.
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R factors in gentamicin-resistant organisms causing hospital infection.
An abrupt increase in gentamicin-resistant isolates was noted in the Manhattan Veterans Administration Hospital in 1973 and 1974. Bacteraemic infection occurred in 17 patients, 9 of whom died. R factors mediating gentamicin resistance were demonstrated in 34 of 36 strains. Organisms from 9 of 11 patients transferred a resistance pattern common to all other isolates from that patient, suggesting in-vivo interbacterial spread of the R factor.
Subacute and acute endocarditis due to Pseudomonas cepacia in heroin addicts.
Five heroin addicts were treated for endocarditis caused by Pseudomonas cepacia. Two of these infections occurred in patients with no known heart disease whereas the others occurred at sites of previous endocarditis or valve prostheses. Infection was indolent in four patients but was associated with shock and skin lesions suggestive of ecthyma gangrenosum in the fifth. After failure of chloramphenicol and kanamycin, all patients were treated with a combination of sulfamethoxazole, trimethoprim and polymyxin plus heart valve resection or replacement.