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Biomedical subjects

P Ispahani

Publications and source records attributed to P Ispahani.

At least 19 recordsLinked to original sources
PubMed1998

Bacteraemia in the adult intensive care unit of a teaching hospital in Nottingham, UK, 1985-1996.

Bacteraemia is an important cause of morbidity and mortality in the intensive care unit. In this study the distribution of organisms causing bacteraemic episodes in patients in the adult intensive care unit of a large teaching hospital was determined. Particular emphasis was placed on the type of organisms isolated from community- and hospital-acquired bacteraemia, the suspected source of infection, the possible risk factors associated with bacteraemia, and outcome. The incidence of bacteraemia and fungaemia increased from 17.7 per 1000 admissions in 1985 to 80.3 in 1996. A total of 315 episodes of bacteraemia and fungaemia were documented over a 12-year period, of which 18% were considered community-acquired and 82% hospital-acquired. Gram-positive and gram-negative bacteria accounted for 46.9% and 31.5% of the episodes, respectively. Polymicrobial infection accounted for 17.8% and fungi for 3.8% of the episodes. Staphylococcus aureus (22.5%), Staphylococcus epidermidis (7.6%), and Streptococcus pneumoniae (7.9%) were the predominant gram-positive bacteria implicated, whereas Escherichia coli (6%), Enterobacter cloacae (7%), Klebsiella aerogenes (3.8%), Pseudomonas aeruginosa (5.1%), and Acinetobacter spp. (3.8%) were the predominant gram-negative bacteria isolated. The two most common sources of infection were the respiratory tract (39.7%) and an intravascular line (24.5%), but in 8.9% of episodes the focus of infection remained unknown. Bacteraemic patients stayed in the unit for a longer period (12 days) than did non-bacteraemic patients (3 days). The overall mortality related to bacteraemia and candidaemia was 44.4%. Surveillance of bacteraemia in the intensive care unit is important in detecting major changes in aetiology, e.g., the increasing incidence of gram-positive bacteraemia, the emergence of methicillin-resistant Staphylococcus aureus in 1995, and the emergence of Enterobacter cloacae. It is of value in determining empirical antimicrobial therapy to treat presumed infection pending a microbiological diagnosis and in directing the development of guidelines for infection prevention, e.g., guidelines for central venous catheter care.

Adolescent↗
PubMed1998

Listeria monocytogenes meningitis in a penicillin-allergic paediatric renal transplant patient.

Currently in many centres the extended spectrum cephalosporins (e.g. cefotaxime and ceftriaxone) are being used empirically for patients with suspected bacterial meningitis. We present a case of meningitis in a penicillin allergic paediatric renal transplant patient from whose cerebrospinal fluid (CSF) Listeria monocytogenes was cultured, despite four days of cefotaxime therapy. The patient was successfully treated with meropenem but required neuro-endoscopic intervention for hydrocephalus.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed1996

Clinical features and antibiotic treatment of septic arthritis and osteomyelitis due to Yersinia enterocolitica.

Yersinia enterocolitica bone and joint infections are rare. Over a period of 7 months four patients with deep-seated skeletal infections due to Y. enterocolitica were seen at the University Hospital, Nottingham. Sites of infection included the knee (one patient) the hip (one) and the spine (two). None of the patients had major underlying disease or risk factors for developing invasive Y. enterocolitica infection. The organisms were sensitive to the second- and third-generation cephalosporins, gentamicin and fluoroquinolones. A literature search covering the period 1970-1994 revealed 20 other cases of skeletal infections due to Y. enterocolitica; there was no uniformity in the choice of antimicrobial agent for treating these infections. Oral ciprofloxacin was used as the principal antimicrobial agent in the patients described here and therapeutic success was achieved in three of these patients. Ciprofloxacin should be considered as first line therapy for invasive infections due to Y enterocolitica.

Administration, Oral↗
PubMed1995

Simultaneous resistance to metronidazole, co-amoxiclav, and imipenem in clinical isolate of Bacteroides fragilis.

A blood-culture isolate of Bacteroides fragilis, taken from a woman after elective laparotomy, was resistant to metronidazole and had reduced susceptibility to imipenem and co-amoxiclav. After treatment with imipenem, pus drained from the pleural cavity yielded an identical isolate that had become highly resistant to imipenem and co-amoxiclav. Emergence of full resistance to the beta-lactam antibiotics was accompanied by a tenfold rise in the specific activity of a metallo-beta-lactamase. Clinicians need to be alert to simultaneous resistance to metronidazole, co-amoxiclav, and imipenem and development of high-level resistance to imipenem in B fragilis during treatment with this agent.

Adult↗
PubMed1995

Streptococcus pneumoniae invasive disease in the neonatal period: an increasing problem?

UNLABELLED: A series of 11 cases of invasive infection with Streptococcus pneumoniae, occurring over an 11-year period, is reported. Eight of the 11 cases occurred during the final 2 years of the study suggesting that the incidence of infection may be increasing. Infection carries a high mortality (3/11). Morbidity includes meningitis, convulsions and respiratory failure. In one case S. pneumoniae meningitis occurred in both mother and newborn. Most mothers who carried the organism were asymptomatic at the time of delivery. CONCLUSION: S. pneumoniae should be specifically sought in swabs taken from the pregnant mother and newborn and if isolated, even in the absence of symptoms, antibiotic therapy against the organism should be strongly considered.

Adolescent↗
PubMed1990

Haemophilus infection in cystic fibrosis.

Twenty seven patients with cystic fibrosis under the age of 12 years and 27 matched patients with asthma were followed up in a prospective study for one year. The isolation rate of non-capsulated strains of Haemophilus influenzae from cough swabs and sputum specimens taken at routine clinic visits every two months was significantly greater in cystic fibrosis than in asthma. Haemophilus para-influenzae was equally common in both groups. During exacerbations the isolation rate of H influenzae in cystic fibrosis was significantly greater than at other times, whereas in asthma there was no significant difference. The distribution of biotypes of H influenzae and H parainfluenzae was similar in the two groups. In cystic fibrosis, biotype I was associated with exacerbations. Biotype V was more common than in previous studies, but was not associated with exacerbations.

Bacterial Typing Techniques↗
PubMed1990

Brain abscess in the 1980s.

Brain abscess was reviewed in 24 patients admitted to University Hospital, Nottingham over a period of 3 years. Chronic ear infection was the most common predisposing factor, but in 11 patients the focus of infection remained unknown. CT scanning, carried out in all patients, was negative in one patient with clinical signs of meningitis. Polymicrobial and anaerobic infections were common. Actinomyces species were isolated in mixed culture from seven patients; in five the abscess was located in the cerebellum. Therapy was most often a combination of surgical drainage and antimicrobial therapy with beta-lactam agents and metronidazole. Evidence suggests that cefotaxime may offer a suitable alternative to chloramphenicol and benzylpenicillin in the treatment of brain abscess.

Actinomycosis↗
PubMed1989

Blood cultures: eight years' experience of a conventional in-house system and trends in antimicrobial susceptibilities.

In a prospective analysis of 4234 significant isolates from 62,437 consecutive sets of blood cultures over an 8 year period, 79.4% were detected within 48 h. Routine examination of Gram-film smears made within 24 h of receipt of the cultures detected about half of all positive cultures. Many organisms were detected earlier on Castaneda slopes than in tryptone soya broth. Haemophilus influenzae (type b) and Neisseria spp. were usually suspected on clinical grounds, and early blind subculture was successful in 95.7% and 69% of cases respectively. Resistance to trimethoprim among Gram-negative coliforms increased significantly over the 8 year period. Production of beta-lactamase was detected in 12% of Haemophilus influenzae (type b). Unlike Staphylococcus aureus, Staphylococcus epidermidis was commonly resistant to methicillin, erythromycin, fusidic acid and gentamicin.

Blood↗
PubMed1988

Rhodotorula rubra ventriculitis.

We describe a case of post-operative ventriculitis in an immunocompetent patient caused by an unusual organism, namely Rhodotorula rubra. The patient was treated successfully with antifungal agents.

Adult↗
PubMed1988

Streptococcus pyogenes bacteraemia: an old enemy subdued, but not defeated.

Bacteraemia with Streptococcus pyogenes (Group A haemolytic streptococci) was reviewed in patients admitted to University Hospital, Nottingham over a period of 7 years. Altogether, 40 cases were encountered, representing 2% of all cases of bacteraemia. Mortality was 35%. Most cases were community-acquired and 28% of patients were less than 40 years of age. A third of the patients were previously fit. The most common sources of bacteraemia were the skin and soft tissue (23 patients) and the respiratory tract (eight patients). Shock was recorded in 40% of cases and carried a 60% mortality. This feature of streptococcal bacteremia has not received sufficient attention in the past. Despite its unique susceptibility to penicillin, S. pyogenes continues to pose a challenge to the physician.

Adolescent↗
PubMed1987

Factors influencing mortality from infective endocarditis in two district general hospitals.

Factors influencing mortality were studied in 92 consecutive cases of infective endocarditis admitted to two district general hospitals between January 1975 and April 1982. Thirty two patients died, an overall mortality of 35%, 13 patients died before diagnosis and 19 despite aggressive antimicrobial therapy. Bactericidal antibiotic levels were monitored in 39 cases but these did not appear to influence outcome. Mortality was lowest for Streptococcus viridans infection (15%) but rose to 50% for infections with S. faecalis and other less common organisms. Most deaths were in patients over 50. Cardiac failure on admission was a poor predictor of mortality, although this was the principal cause of death during treatment (14 cases). Eight patients had emergency valve replacement and 3 died post-operatively. When the diagnosis was missed during life (13 cases) arterial embolus was a common presenting feature (46%). Classical signs of endocarditis, other than pyrexia, were absent. A cardiac murmur (always mitral incompetence) was noted in only 6 cases and considered to be insignificant.

Age Factors↗