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Biomedical subjects

M T Cafferkey

Publications and source records attributed to M T Cafferkey.

At least 37 records · Page 2Linked to original sources
PubMed1990

Management of tonsillitis by the general practitioner.

Seventy-eight of 107 general practitioners completed a questionnaire to assess the management of recurrent acute tonsillitis by the primary care physician. Penicillin was the antibiotic of choice in acute tonsillitis, used by 74 (95%) respondents. Of these, 45% recommended ampicillin/amoxycillin. In the case of penicillin allergy, 67 (86%) chose erythromycin. For the treatment of tonsillitis unresponsive to initial therapy, a wide variety of agents were quoted; the most common being erythromycin (27 cases, 35%) and co-trimoxazole (16 cases, 20%). There were 17 separate indications for surgical referral given, the most common being recurrent tonsillitis (68 cases, 87%). Two or more reasons for surgical referral were stated by 55 (71%) GPs. These findings are discussed with particular reference to recent reports of penicillinase producing bacteria in association with recurrent acute tonsillitis.

Erythromycin↗
PubMed1989

Yersinia infections in surgical practice.

This article reviews the clinical manifestations of Yersinia bacteria emphasizing their recent rise in incidence and describing how Yersinia infection presents to the general surgeon. Geographical variations, patterns of disease, pathogenicity and the problems in diagnosis and management are discussed. This common but often unrecognized infection is usually self-limiting but the very young, the very old and the immunocompromised are at greater risk and prompt treatment is required to save lives.

Gastroenteritis↗
PubMed1989

Study of appropriate antibiotic therapy in transurethral prostatectomy.

Septicaemia is the commonest cause of morbidity and mortality following transurethral prostatectomy. Routine blind antibiotic prophylaxis is not always effective and there is a tendency to over-use potent new and expensive antimicrobials. Attempts to "sterilise" the urine preoperatively are also expensive and disruptive. However, appropriate treatment/prophylaxis can be administered economically using rapidly obtained laboratory results. We describe here a technique of routine direct antibiotic sensitivity testing (DST) of the patient's urine pre-operatively and before catheter removal. Such testing can be performed by junior medical staff in a ward side-room. An appropriate antibiotic may then be administered parenterally 1 h before surgery or catheter removal. A total of 102 consecutive patients underwent TURP and only 1 of those with infected urine became septicaemic. In this instance, an appropriate antibiotic had been incorrectly given orally before removal of the catheter. If the antibiotic sensitivities of a patient's urine are known, and an appropriate antibiotic is given parenterally 1 h pre-operatively or before catheter removal, the incidence of septicaemia following transurethral surgery may be significantly reduced.

Anti-Bacterial Agents↗
PubMed1989

Production of bacteriocin-like antagonism by clinical isolates of Yersinia enterocolitica.

Fourteen clinical isolates of Yersinia enterocolitica serotype O:3 and four well-documented virulent strains of serotypes O:3, O:8, and O:9 were biotyped and examined for plasmid-associated autoagglutination and calcium dependency and for epithelial cell adherence. These strains were tested for the production of bacteriocin-like antagonism by using tryptone soya blood agar at room temperature and at 37 degrees C. By using the cross-streaking method, three clinical isolates produced inhibitory substances at room temperature. These substances were active against a variety of clinical isolates and their plasmid-cured derivatives at both room temperature and 37 degrees C. The inhibition was easier to read after incubation of the cross-streaked plate at 37 degrees C. The inhibition patterns indicate that two of the three producer strains appear to recognize potentially virulent O:3 strains, with or without the virulence plasmid.

Antibiosis↗
PubMed1988

Sources and outcome for methicillin-resistant Staphylococcus aureus bacteraemia.

Eighty-eight episodes of MRSA septicaemia occurring in 82 patients were studied prospectively. In 15 episodes bacteraemia was transient, in 36 non-fatal, in 33 fatal, while in four septicaemia was a major contributory factor in the patient's death. There were more patients aged over 60 years in the septicaemia groups compared to the transient bacteraemia group (P = 0.01), and patients with septicaemia were usually recently postoperative and/or suffering from severe underlying disease. Circulation access sites were the commonest source of the bacteraemic organisms with non-surgical wounds including burns, varicose ulcers and bed sores as the next most common. In four of the 16 burns patients, fatal septicaemia followed surgical debridement of infected burns. In only eight episodes was there no apparent source of bacteraemia.

Adolescent↗
PubMed1988

Yersinia-induced uveitis in Ireland.

A prospective study was undertaken on 54 patients with an apparently idiopathic first attack of acute anterior uveitis. Blood samples were assayed for antibodies to Yersinia enterocolitica and Yersinia pseudotuberculosis, and tested for HLA type. Thirteen patients were found to have serological evidence of recent yersinia infection, eight with Y. enterocolitica and five with Y. pseudotuberculosis. The clinical course of uveitis did not differ from that typically found in HLA-B27 positive patients. Five patients were observed to develop non-ocular inflammation at a variable interval. The means by which eye inflammation follows yersinia infection is discussed in the light of recent theories on pathogenesis of HLA-B27 associated diseases.

Adult↗
PubMed1988

Pulmonary infection due to methicillin-resistant Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) are now causing severe clinical infection on a worldwide basis. Pulmonary infection due to MRSA although widely reported is poorly documented. We report the predisposing factors, underlying diseases, treatment and outcome in 4 patients with pneumonia, 3 patients with empyema thoracis, 1 patient with pneumonia and empyema thoracis, 1 patient with pneumonia plus lobectomy wound infection and 2 patients with lung abscess. Vancomycin was highly effective in treatment, a finding compatible with experience treating other severe MRSA infections.

Adolescent↗
PubMed1988

Association of reactive arthropathy and Morganella morganii cross reacting with Yersinia enterocolitica.

Two patients exhibited reactive arthropathy in association with chronic diarrhoea and abdominal pain. Rising titres of agglutinating antibody to Yersinia enterocolitica O3 were observed in association with arthropathy. Morganella morganii was isolated from faeces of one patient in heavy growth. In both patients, absorption of the sera with morganella antigen abolished yersinia reactivity. Morganella titres were more than 8 times the yersinia titres and were unaffected by absorption with Yersinia. Neither patient had detectable antibody to the predominant enterobacterial species present in faeces. One patient developed acute cystitis with Proteus mirabilis and had no serological response to the proteus isolate. We conclude that the elevated morganella titres were specific. The role of M. morganii in intestinal disorders remains to be established, but from our findings, it should be added to the list of organisms associated with reactive arthropathy.

Adult↗
PubMed1987

Yersinia infection and acute abdominal pain.

In 194 patients presenting with acute abdominal pain from whom sequential serum samples were taken, the frequency of yersiniosis, established serologically, was significantly higher (23%) than in 320 control subjects (2%). Yersiniosis occurred in 31% of patients with acute appendicitis. Acute-phase serum samples only, obtained in a further 307 patients, yielded a falsely low frequency of yersiniosis (4%). Y pseudotuberculosis was five times more common than Y enterocolitica, and Y pseudotuberculosis type IV was the most common serotype, accounting for 43% of Yersinia infections. Yersinia may play a more important part in the aetiology of acute abdominal pain, and particularly acute appendicitis, than has been previously appreciated. Antibody titres to both Y enterocolitica and Y pseudotuberculosis frequently rise late in infections causing abdominal pain. Consequently analysis of acute-phase serum samples alone leads to underdiagnosis of yersiniosis.

Abdomen↗
PubMed1987

High appendicectomy rates in Ireland: why?

Age-specific appendicectomy rates for Ireland have recently been reported to be substantially higher than those for Scotland. We attempted to determine the reason for this difference. Records of 940 appendectomies performed in one urban and one rural centre in Ireland over a 12 month period were examined to establish the frequency of acute appendicitis. Appendicitis rates were derived from these data. Appendicectomy rates are higher in Ireland because the incidence of acute appendicitis is greater than in Scotland or England and Wales and are not the result of variations in medical practice.

Acute Disease↗
PubMed1986

Osteomyelitis with methicillin-resistant Staphylococcus aureus.

We describe 10 patients with hospital-acquired osteomyelitis due to methicillin-resistant Staphylococcus aureus. The patients were posttraumatic and eight had a foreign body in situ at the site of infection. Vancomycin therapy in association with radical debridement was followed by clinical and radiological cure in eight patients at 2-3.5 years follow-up, in two of whom a foreign body was left in situ. Only minor adverse effects of vancomycin therapy (one rash, two thrombophlebitis) were seen.

Adult↗
PubMed1985

Methicillin-resistant Staphylococcus aureus in Dublin 1971-84.

Between 1971 and 1975, methicillin-resistant Staphylococcus aureus (MRSA) caused sporadic infection in eight Dublin hospitals although a case of bacteraemia was not recorded until 1976. From then on gentamicin-resistant MRSA rapidly became endemic in Dublin hospitals. The frequency of MRSA bacteraemia reached a peak in 1979-82 but MRSA infection remains an important problem. The most effective antimicrobial agent in treatment of invasive infection was vancomycin; little drug toxicity was seen. Where appropriate, concomitant surgical treatment such as debridement and drainage was usually necessary. Infection control measures directed at eliminating carriage proved effective in reducing spread. Molecular analysis showed two distinct MRSA phenotypes with similar phage-typing patterns. Gentamicin resistance was chromosomally encoded.

Gentamicins↗
PubMed1985

Susceptibility to antimicrobial agents and analysis of plasmids in gentamicin- and methicillin-resistant Staphylococcus aureus from Dublin hospitals.

Methicillin- and gentamicin-resistant Staphylococcus aureus (MGRSA) strains isolated from Dublin Hospitals were classified into two groups (phenotypes). Phenotype-I strains expressed high level resistance to gentamicin and were susceptible to fusidic acid; strains resistant to tetracycline harboured a 3 X 10(6)-mol. wt plasmid. Strains in phenotype II usually expressed low level resistance to gentamicin, were resistant to fusidic acid and often harboured a (22-24) X 10(6)-mol. wt plasmid that specified resistance to ethidium bromide, tetracycline, kanamycin, neomycin and trimethoprim, or to combinations of these markers. A few phenotype-II strains expressed higher levels of resistance to gentamicin and other aminoglycosides. All MGRSA strains carried a 21 X 10(6)-mol. wt plasmid conferring resistance to penicillin, ethidium bromide, cadmium and mercury. Gentamicin resistance was invariably chromosomal and all strains carried chromosomal resistance to methicillin, erythromycin, streptomycin and spectinomycin. Several methicillin-resistant S. aureus (MRSA) strains isolated before the emergence of gentamicin resistance harboured a 21 X 10(6)-mol. wt penicillinase plasmid with the same restriction endonuclease profile as that from some MGRSA strains. Some MRSA strains carried other plasmids related to those found in MGRSA strains.

Anti-Bacterial Agents↗
PubMed1985

Antimicrobial chemotherapy of septicemia due to methicillin-resistant Staphylococcus aureus.

The outcome of treatment of 48 episodes of septicemia due to methicillin-resistant Staphylococcus aureus (MRSA) in 44 patients was assessed. Twenty-six of the patients died; nineteen of them died of infection, and infection was a major contributing factor to the deaths of the remaining seven patients. Fourteen of fifteen patients treated with inadequate antibiotic therapy died, and the other patient developed a mycotic aneurysm of the femoral artery, for which amputation was necessary. Eight of eleven patients treated with amikacin (alone or combined with another antimicrobial) died, and three recovered slowly; only one recovered fully without sequelae. In an additional two patients who failed to respond to amikacin, treatment was changed to vancomycin. Vancomycin was used to treat 18 episodes of MRSA septicemia in 17 patients. In 14 of these episodes the patients recovered fully. One patient died of uncontrolled infection, and in three, infection was a contributing factor but not the major cause of death. Vancomycin was confirmed as antibiotic of choice in treating MRSA septicemia.

Adult↗