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Biomedical subjects

M W Kline

Publications and source records attributed to M W Kline.

At least 73 records · Page 4Linked to original sources
PubMed1989

The role of aztreonam in treatment of complicated urinary tract infections in children.

Urinary tract infections are common among pediatric patients, occurring in approximately 2% of children within the first 5 to 10 years of life. Most urinary tract infections are uncomplicated and respond readily to treatment. However, complications may make treatment difficult and result in serious adverse sequelae. Several characteristics of aztreonam make it an attractive alternative to aminoglycosides and certain other antibiotics for the treatment of complicated urinary tract infections in children. It has been shown, for example, that the drug is highly active against most of the pathogenic organisms responsible for urinary tract infections in the pediatric population, as well as Pseudomonas aeruginosa and many less common, aminoglycoside- and cephalosporin-resistant Gram-negative bacteria. Aztreonam is widely distributed throughout the body and achieves potentially therapeutic concentrations in the kidneys and in urine for up to 24 hours after dosing. The efficacy and safety of this agent compare favorably with standard antibiotic agents. Aztreonam is associated with high rates of microbiologic and clinical cures, and the few side effects reported have been mild and transient.

Aztreonam↗
PubMed1989

Septic shock: principles of management in the emergency department.

Bacteremia is a potentially serious event which must be recognized early and treated aggressively to prevent progression to septicemia and septic shock. The pathophysiology of septicemia and shock includes inadequate tissue perfusion and oxygenation. Expansion of intravascular volume and pharmacologic cardiovascular support are designed to minimize resulting end-organ injury. Initial antibiotic therapy must be individualized and should include an agent or agents active against the common pathogens encountered in the specific clinical setting. Once the causative organism is isolated, therapy is targeted more narrowly. Despite the availability of a variety of newer antibiotics, the morbidity and mortality of septicemia and septic shock remain unacceptably high. Development of new pharmacologic agents active against the mediators of shock may offer future promise.

Emergency Service, Hospital↗
PubMed1989

Evaluation of the Abbott TESTPACK RSV enzyme immunoassay for detection of respiratory syncytial virus in nasopharyngeal swab specimens.

The Abbott TESTPACK RSV assay (Abbott Laboratories, North Chicago, Ill.), a rapid (20-min) enzyme immunoassay, was compared with culture and direct immunofluorescence (DFA) of nasopharyngeal cells for the detection of respiratory syncytial virus (RSV) in nasopharyngeal swab specimens. Nasopharyngeal swab specimens, collected from 234 infants, were placed in viral transport medium. Portions of specimen in transport medium were used for each test. Of 234 specimens, 70 (30%) were culture positive, 103 (44%) were DFA positive, 107 (46%) were culture or DFA positive, and 112 (48%) were TESTPACK RSV positive. Of 19 specimens positive by TESTPACK RSV but negative by culture or DFA, 15 were positive by the blocking assay. A total of 122 specimens were culture, DFA, or blocking assay positive; TESTPACK RSV detected 108 specimens (sensitivity, 89%). The specificity, positive predictive value, and negative predictive value of TESTPACK RSV as compared with those of culture, DFA, and the blocking assay were 96, 96, and 89%, respectively. By comparison, the sensitivity, specificity, positive predictive value, and negative predictive value of combined culture and DFA were 88, 100, 100, and 88%, respectively. TESTPACK RSV is a rapid and reliable enzyme immunoassay for the direct detection of RSV antigen in nasopharyngeal swab specimens.

Fluorescent Antibody Technique↗
PubMed1989

Epidemiologic marker system for Citrobacter diversus using outer membrane protein profiles.

Investigations of nursery outbreaks of Citrobacter diversus sepsis and meningitis have been hampered by lack of adequate epidemiologic markers for the organism. We studied outer membrane protein profiles from clinical isolates of C. diversus by sodium dodecyl sulfate-polyacrylamide gel electrophoresis to determine whether this method might be useful in the epidemiologic differentiation of strains. Paired cerebrospinal fluid isolates from each of three separate nursery outbreaks of C. diversus meningitis, paired isolates from the vagina of a postpartum woman and the cerebrospinal fluid of her newborn infant, one isolate from an infant with pneumonia and two from colonized nursery cohorts, and 30 epidemiologically unrelated clinical isolates were included. Eleven distinct profiles were differentiated by the presence or absence of five outer membrane proteins. Complete concordance of profiles was observed for epidemiologically related isolates. Unrelated epidemic strains had outer membrane protein profiles distinct from one another. Biotyping complemented determination of outer membrane protein profiles; the two markers differentiated each of the five epidemic strains from all but one of 30 unrelated nonepidemic isolates. Determination of outer membrane protein profiles is potentially useful in epidemiologic investigations of disease caused by C. diversus.

Bacterial Outer Membrane Proteins↗
PubMed1989

Sudden-onset deafness. Serodiagnosis of recent meningococcal infection.

An 8.5-year-old boy was evaluated 3 weeks after the occurrence of a febrile illness associated with sudden-onset deafness. An extensive diagnostic evaluation was largely unrewarding. However, unusual epidemiologic features of the case and cerebrospinal fluid abnormalities suggested meningococcal meningitis as the probable etiology. Serologic studies confirmed recent meningococcal infection. The potential etiologies of sudden acquired deafness are diverse, but a thorough evaluation is warranted and may be rewarding, even if it is initiated weeks after onset of deafness.

Child↗
PubMed1988

Methicillin-resistant Staphylococcus aureus: pediatric perspective.

Methicillin-resistant S. aureus has emerged as a nosocomial pathogen of major importance in pediatric patients. Infection occurs most often in hospitalized individuals with underlying predisposing medical conditions. Any body site may be involved, and bacteremia frequently occurs concomitantly. Vancomycin is the antibiotic of choice for serious MRSA infections; PRPs and cephalosporins generally are not effective. The likelihood of an adverse outcome of infection increases with the severity of an underlying condition and delay in institution of appropriate therapy. Infection control measures have met with only limited success in eradicating MRSA from the hospital environment. Methicillin-resistant S. aureus is likely to remain of considerable clinical significance to physicians caring for seriously ill children.

Child↗
PubMed1988

Characterization of Citrobacter diversus strains causing neonatal meningitis.

We studied 17 strains of Citrobacter diversus isolated from the cerebrospinal fluid of infants with meningitis and compared these strains with 21 strains isolated from other body sites. The two groups of strains were similar with respect to biotype, piliation, hemolysin production, and resistance to the killing effects of serum. By using sodium dodecyl sulfate-polyacrylamide gel electrophoresis, we found that 14 (82%) of 17 strains from cerebrospinal fluid, but only two (10%) of 21 strains isolated from other body sites, possessed a minor outer membrane protein with a molecular weight of 32,000 (P less than .0001). This protein may serve as a marker for strains of C. diversus that are likely to cause meningitis or brain abscess in human neonates.

Bacterial Outer Membrane Proteins↗
PubMed1988

Pathogenesis of brain abscess formation in an infant rat model of Citrobacter diversus bacteremia and meningitis.

The pathogenesis of Citrobacter diversus meningitis and brain abscess was studied in infant rats. Two-day-old rats were inoculated intraperitoneally and intranasally with C. diversus. C. diversus strain 4277, lacking the 32,000-molecular-weight outer membrane protein that appears to be a marker for strains causing meningitis in human neonates, was more likely to produce bacteremia, meningitis, and death in rats than was strain 4036, which possesses this outer membrane protein. Strain 4036 was, however, more likely than strain 4277 to produce ventriculitis and brain abscess. In the infant rat, central nervous system involvement by C. diversus begins with bacteremia and leptomeningitis, followed by ventriculitis and direct extension of infection into periventricular brain parenchyma. Large numbers of bacteria persist inside inflammatory cells, an observation suggesting resistance to intraphagocytic killing. Bacterial strain differences, possibly related to the presence of a 32,000-molecular-weight outer membrane protein, may account for histopathologic differences in the brains of infant rats with C. diversus meningitis.

Animals↗
PubMed1988

Computed tomography in bacterial meningitis of childhood.

The hospital records of 85 children with bacterial meningitis were reviewed and a subset of 25 children who underwent computed tomography of the head were identified. The major stated indications for computed tomography were fever (8 patients), seizures (4 patients), signs of increased intracranial pressure (4 patients), focal neurologic dysfunction (3 patients) and recurrent meningitis (2 patients). Abnormal findings were demonstrated by computed tomography in 20 of 25 patients but in 8 patients consisted solely of nonspecific dilatation of spaces containing cerebrospinal fluid or of basilar enhancement. The yield of information that was useful either diagnostically or therapeutically was low; positive findings of obvious clinical relevance were present in only 2 cases. Computed tomography provides an accurate means of diagnosing intracranial complications of bacterial meningitis. It must be used conservatively, however, to limit expense and radiation exposure and enhance the yield of potentially relevant information. Computed tomography is indicated for children with persistent neurologic dysfunction, persistently positive cerebrospinal fluid cultures or recurrent meningitis, whereas it is of little value for children with prolonged fever alone.

Adolescent↗
PubMed1987

Comparative in-vitro activity of LY146032 and eight other antibiotics against gram-positive bacteria isolated from children.

LY146032, a cyclic peptide antibiotic active against many Gram-positive bacteria, was compared to methicillin, vancomycin, clindamycin, cefuroxime and gentamicin against methicillin-resistant and methicillin-susceptible strains of Staphylococcus aureus and Staph. epidermidis. LY146032 was uniformly active against clinical isolates of staphylococci, inhibiting 90% of strains of Staph. aureus and Staph. epidermidis at a concentration of 0.5 mg/l. Vancomycin was slightly less active than LY146032 against Staph. aureus and Staph. epidermidis, inhibiting 90% of strains at concentrations of 1.0 and 2.0 mg/l, respectively. All other antibiotics tested were less active than LY146032 or vancomycin against staphylococci. LY146032 was compared to penicillin, ampicillin, vancomycin and chloramphenicol against strains of Streptococcus pneumoniae, group B streptococcus, group D streptococcus (enterococcus) and Listeria monocytogenes and was found to inhibit 90% of the strains at concentrations of 0.25, 1.0, 32.0 and 16.0 mg/l respectively. The combination of LY146032 and chloramphenicol was antagonistic in vitro for one strain each of Staph. aureus and group D streptococcus and showed indifference against other strains of Staph. aureus(2), Staph. epidermidis(2), group D streptococcus(1) and L. monocytogenes(2). LY146032 in combination with gentamicin showed indifference against the same bacteria. On the basis of its in-vitro activity, LY146032 appears to be a promising agent for the treatment of serious community- and hospital-acquired staphylococcal infections.

Anti-Bacterial Agents↗