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P J Collignon

Publications and source records attributed to P J Collignon.

49 records · Page 3Linked to original sources
PubMed1987

Extrapulmonary tuberculosis--a continuing problem in Australia.

Extrapulmonary tuberculosis (TB) remains a major health problem in Australia, with 24.3% of all new tuberculosis notifications in 1984 of extrapulmonary origin. We have reviewed our recent experience to assess the epidemiology and clinical features that may allow the earlier recognition and treatment of patients at risk for this disease. From 1980-1985, 51 cases of extrapulmonary TB were identified at Westmead Hospital. Thirty-eight patients were born outside Australia, mainly in South-East Asia and Europe. The commonest sites of disease were the lymph nodes, genitourinary tract, pleura and bone. Tuberculous lymphadenitis occurred predominantly in South-East Asians, whilst genitourinary tract disease was confined to Caucasians. A history of previous exposure to tuberculosis was obtained in 45% of patients. Fever, sweats and weight loss were noted in less than half of the cases. Changes consistent with old pulmonary disease were found on routine chest X-ray in 34% of cases. Laboratory confirmation of TB was made in 88% of cases, with typical histopathology in 90% and isolation of Mycobacterium tuberculosis in 69% of specimens submitted for analysis. Drug resistance was confined to isolates from South-East Asian patients.

Asia, Southeastern↗
PubMed1986

Propionibacterium acnes infection in neurosurgical patients. Experience with high-dose penicillin therapy.

Propionibacterium acnes is an underestimated but significant cause of cerebrospinal fluid (CSF) infection after neurosurgical procedures and in the presence of prosthetic devices. The most effective therapy for such infections has not been defined. We report here our experience with the use of high-dose penicillin in the treatment of six patients with postoperative infection which was caused by P. acnes. All patients received 3-4 million units of penicillin by the intravenous route every four hours, in combination with surgical drainage and removal of prosthetic devices where appropriate. All but one of the patients recovered from their infection. The remaining patient responded to penicillin but died of a massive intraventricular haemorrhage after 12 days. Isolates of P. acnes had minimal inhibitory concentrations to penicillin that ranged from 0.03-0.12 mg/L. No adverse reactions to penicillin were recorded. We conclude that high-dose intravenous penicillin therapy, in combination with surgical drainage and removal of foreign bodies, constitutes appropriate therapy for CSF infections that are due to P. acnes.

Combined Modality Therapy↗
PubMed1986

Is semiquantitative culture of central vein catheter tips useful in the diagnosis of catheter-associated bacteremia?

Semiquantitative culturing of catheter tips has been used as an index of catheter-related bacteremia. As the sensitivity and predictive values of this test have not been determined, we studied 780 tips from central vein catheters inserted into 440 critically ill patients in an intensive care unit. The results were correlated with clinical data for 30 bacteremic episodes which occurred in these patients, 14 of which were catheter related. When five or more colonies per plate were taken as a positive result, the sensitivity of the method was 92%, and the specificity was 83%. Although the predictive value of a negative result was excellent (99.8%), the predictive value of a positive result was low (8.8%) in our patient population, which had a relatively low incidence of catheter-related bacteremia (2%). We conclude that a semiquantitative culture technique is useful in the diagnosis of bacteremia associated with central vein catheters.

Bacteria↗
PubMed1985

Prevention of sepsis associated with the insertion of intravenous cannulae. The experience in a coronary care unit.

The effect of a strictly maintained treatment protocol on the incidence of bacteraemia associated with peripheral intravenous catheters was studied in a coronary care unit. This protocol was supervised and carried out by nursing staff members. Before the introduction of the protocol in October 1981, Staphylococcus aureus bacteraemia associated with peripheral intravenous catheters had developed in five patients and led to the deaths of four of these patients. During this time, 2364 patients were admitted to the unit. Since October 1981, there have been no further episodes of systemic sepsis associated with peripheral intravenous catheters in 2279 patients admitted to the unit (P = 0.03; Fisher's exact test).

Australia↗
PubMed1985

A prospective study of adverse reactions associated with vancomycin therapy.

A prospective evaluation of the efficacy and safety of vancomycin was conducted in 54 consecutive patients over a 16-month period. Vancomycin was curative in 95% of 43 patients with proven infection. Drugs were ceased in six patients because of adverse reactions; in three of these vancomycin was considered the likely cause. Reactions included thrombophlebitis (20 of 54 patients), rash (4 of 54), nephrotoxicity (4 of 50), proteinuria (1 of 50) and ototoxicity (1 of 11 patients tested by audiometry). Thrombophlebitis occurred only with infusion through peripheral cannulae; nephrotoxicity and ototoxicity were confined to patients receiving an aminoglycoside plus vancomycin. We conclude that vancomycin, administered appropriately, constitutes safe, effective therapy for infections caused by susceptible bacteria.

Adolescent↗
PubMed1984

Systemic sepsis and intravenous devices. A prospective survey.

Seventy-five episodes of bacteraemia or fungaemia related to indwelling temporary intravenous devices were assessed by the Infectious Diseases Unit of The Westmead Centre, to determine the quality of care of these devices. The estimated incidence of systemic sepsis was 1% for all central venous catheters inserted and 0.1% for all peripheral venous catheters inserted. Sepsis was a major cause of death in 14 of 17 patients who died. Despite the existence of protocols for the insertion, management and early removal of intravenous devices, factors increasing the risk of sepsis included delay in the removal of the intravenous device and the presence of thrombophlebitis. Staphylococcus aureus was the most common isolate (41%); antibiotic resistant Gram-negative rods were also common (38%). It is concluded that continued education of resident and nursing staff is essential to minimize the risk of intravenous catheter-related sepsis.

Catheters, Indwelling↗
PubMed1984

Exogenous ocular candidiasis associated with intravenous heroin abuse.

Seven young men developed disseminated candidiasis within 10 days of a single episode of intravenous heroin abuse. Sequential development of eye and skin lesions was noted in all cases. The bone or costal cartilage was involved in five. Ocular manifestations of candidiasis included episcleritis, chorioretinitis, and endophthalmitis. A presumptive diagnosis of candida chorioretinitis was established rapidly by culture of Candida albicans from involved skin and costal cartilage. Systemic therapy with amphotericin B plus 5-fluorocytosine resulted in cure of the episcleritis, chorioretinitis, osteomyelitis, costochondritis, and skin infection. Pars plana vitrectomy with local instillation of amphotericin B was required to cure chorioretinitis associated with vitreal extension of infection.

Adult↗
PubMed1984

Is the antimicrobial removal device a cost-effective addition to conventional blood cultures?

Two hundred and thirty-four blood cultures from 140 patients receiving antibiotics were processed using the antimicrobial removal device (ARD) in parallel with conventional blood cultures. One hundred and seventy cultures were obtained from patients suspected to have bacteraemia and 64 from patients known to have a positive conventional blood culture within the preceding three days. A total of 38 (16.2%) ARD-processed cultures were positive, compared with 21 (8.9%) conventional cultures (p less than 0.0001, Fisher's exact test). No instances of positive conventional cultures and negative ARD-processed cultures were identified. Thirty-three of 38 ARD-processed cultures became positive within 24 h, compared with 14 parallel conventional cultures (p less than 0.0001 Fisher's exact test). Although the yield and rapidity of isolation of bacteria from blood were improved by ARD processing, in only one of 140 patients did this information alter treatment. As the use of an ARD is associated with a sixfold increase in the cost of blood cultures, we conclude that, in our hands, general use of the device in patients receiving antibiotics is not cost-effective. Considerable care should be taken in selecting patients for ARD-processing of blood cultures.

Anti-Bacterial Agents↗
PubMed1983

Disseminated candidiasis: evidence of a distinctive syndrome in heroin abusers.

Seven young men developed similar manifestations of disseminated candidiasis after a single episode of intravenous heroin abuse. Sequential development of lesions of the eye, skin, and bone or costal cartilage was noted within 10 days after injection. Skin lesions were confined to the scalp and other hair bearing areas. Candida albicans was cultured readily from affected skin and costal cartilage. Histological examination of scalp biopsy specimens showed infiltration of hair follicles with chronic inflammatory cells and C albicans. Pseudohyphas of C albicans were also identified in and around hair shafts. The skin, skeletal, and small eye lesions resolved on systemic treatment with 1 g amphotericin B plus flucytosine. Pars plana vitrectomy plus local instillation of amphotericin B cured progressive chorioretinitis. These features may represent a distinctive syndrome of disseminated candidiasis in heroin abusers. Systemic antifungal treatment is curative in most cases.

Candidiasis↗
PubMed1983

Neurological toxicity associated with vidarabine (adenine arabinoside) therapy.

Disorientation, myoclonic jerks, generalised rigidity and tremor developed in a young woman while on treatment with vidarabine for disseminated cutaneous varicella. Residua were still present 11 months later. She had normal renal function and was being treated with relatively low dose vidarabine therapy. A possible drug interaction with allopurinol is described.

Adult↗