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Biomedical subjects

R A Garibaldi

Publications and source records attributed to R A Garibaldi.

At least 37 records · Page 2Linked to original sources
PubMed1986

Infections in the elderly.

Elderly patients appear to be predisposed to serious infections because of coexisting chronic or acute diseases that disrupt integumental barriers, impair clearance mechanisms, or compromise cellular responses to infection. The severely disabled elderly are particularly at high risk, because they are often unable to care for their personal hygiene and are malnourished, immobile, incontinent, or institutionalized. Senescence of the immune system per se does not appear to be a major predisposing factor for infection in this population. Infections in the elderly frequently present with non-specific signs and symptoms. Clues of focal infection are often absent or obscured by underlying chronic conditions. Once a site of infection is identified, clinicians should initiate therapy with broad-spectrum antibiotics to treat the array of most likely potential pathogens. Strategies to prevent infection include programs to help the elderly maintain active, non-institutionalized life-styles and the appropriate use of available vaccines.

Aged↗
PubMed1986

Comparison of nonwoven and woven gown and drape fabric to prevent intraoperative wound contamination and postoperative infection.

In a prospective, controlled clinical trial, nonwoven, disposable gown and drape fabrics were no better barriers to intraoperative wound contamination or postoperative wound infection than reusable cotton poplin. We observed no difference between the two study groups in either the frequency or level of intraoperative wound contamination as judged by cultures of specimens collected at the time of wound closure. Of procedures in which reusable fabrics were used, 13.1 percent had positive cultures compared with 15.5 percent of those in which disposable fabrics were used (difference not statistically significant). We recovered coagulase-negative Staphylococci from more than 95 percent of contaminated wounds. Rates of postoperative wound infection were virtually identical in the two groups. Our data suggest that either both fabrics were similar in their ability to block bacteria that were shed from skin surfaces from entering the wound, or that bacteria which contaminate the wound in clean surgical procedures are derived from sources other than skin.

Clinical Trials as Topic↗
PubMed1986

Postcholecystectomy wound infection. The impact of prophylactic antibiotics on the epidemiology of infections.

The clinical courses of 347 patients undergoing gallbladder surgeries were monitored to study the epidemiology of postcholecystectomy wound infection in a hospital in which high-risk patients received prophylactic antibiotics. Overall, 3.8% of patients had wound infections. Patients who had positive bile cultures taken during surgery or positive intraoperative wound cultures had higher rates of infection than patients with negative cultures. However, there was a poor correlation among the bacterial isolates that were recovered from the bile or the wound surface during surgery and from postoperative infections. Antibiotic-sensitive enteric bacteria were recovered from bile samples at surgery, gram-positive organisms and enteric gram-negative bacteria were isolated from intraoperative cultures of the wound surface, and antibiotic-resistant gram-negative bacteria or enterococci were recovered from wounds that developed postoperative infections. There was a strong association between the prior receipt of prophylactic antibiotics and infections with antibiotic-resistant bacteria. Data suggest that bactibilia is still an important epidemiologic marker that identifies patients at high risk for subsequent wound infection. However, in patients who have received prophylactic antibiotics, intraoperative cultures cannot be relied on to guide the choice of empiric therapeutic antibiotics for postoperative infections. Bacteria responsible for these infections are not identified by cultures taken at the time of surgery and are often resistant to the class of antibiotics used for prophylaxis.

Adolescent↗
PubMed1985

Epidemiology of community-acquired respiratory tract infections in adults. Incidence, etiology, and impact.

Upper respiratory tract infections are the most common types of infectious diseases among adults. It is estimated that each adult in the United States experiences two to four respiratory infections annually. The morbidity of these infections is measured by an estimated 75 million physician visits per year, almost 150 million days lost from work, and more than $10 billion in costs for medical care. Serotypes of the rhinoviruses account for 20 to 30 percent of episodes of the common cold. However, the specific causes of most upper respiratory infections are undefined. Pneumonia remains an important cause of morbidity and mortality for nonhospitalized adults despite the widespread use of effective antimicrobial agents. There are no accurate figures on the number of episodes of pneumonia that occur each year in ambulatory patients. In younger adults, the atypical pneumonia syndrome is the most common clinical presentation; Mycoplasma pneumoniae is the most frequently identified causative agent. Other less common agents include Legionella pneumophila, influenza viruses, adenoviruses, and Chlamydia. More than half a million adults are hospitalized each year with pneumonia. Persons older than 65 years of age have the highest rate of pneumonia admissions, 11.5 per 1,000 population. Pneumonia ranks as the sixth leading cause of death in the United States. The pathogens responsible for community-acquired pneumonias are changing. Forty years ago, Streptococcus pneumoniae accounted for the majority of infections. Today, a broad array of community-acquired pathogens have been implicated as etiologic agents including Legionella species, gram-negative bacilli, Hemophilus influenzae, Staphylococcus aureus and nonbacterial pathogens. Given the diversity of pathogenic agents, it has become imperative for clinicians to establish a specific etiologic diagnosis before initiating therapy or to consider the diagnostic possibilities and treat with antimicrobial agents that are effective against the most likely pathogens.

Adolescent↗
PubMed1985

Evidence for the non-infectious etiology of early postoperative fever.

In a prospective study of infections in 871 general surgery patients, we identified 81 patients who developed unexplained postoperative fevers. The majority of these episodes (72%) occurred early (within the first 48 hours) following surgery. Patients who developed early, unexplained fevers differed significantly from patients who developed documented postoperative infections. Patients with unexplained fevers were younger, had less severe underlying disease and underwent less extensive surgeries than patients who subsequently developed infections. In these respects, they were more similar to non-infected, non-febrile patients. We concluded that episodes of early, unexplained postoperative fever occur frequently in a wide range of general surgery patients. Most of these episodes are non-infectious in origin. Patients with early postoperative fevers should be evaluated to identify any obvious sources of infection. If no focus is identified, empiric antibiotic therapy should not be initiated nor should prophylactic antibiotics be extended for prolonged durations. Unexplained fevers will resolve in time without specific therapeutic interventions.

Age Factors↗
PubMed1985

A multi-hospital hepatitis B vaccine program: prevalence of antibody and acceptance of vaccination among high-risk hospital employees.

In July 1982, five Hartford hospitals embarked on a joint hospital-sponsored program to immunize high-risk employees against hepatitis B virus (HBV). The program included a questionnaire to characterize relative risk, serology for anti-HBs, vaccination and a follow-up survey of vaccine non-recipients. Of 2,065 employees who were considered to be at high-risk for infection with HBV, 1,894 (91.7%) responded to the screening questionnaire and 1,279 (67.5%) were tested for anti-HBs serology. The prevalence of antibody varied from hospital to hospital; the highest prevalence (10.9%) was observed at one of the urban university-affiliated community hospitals and the lowest prevalence (4.1%) was reported from the smaller, rural hospital. The prevalence of antibody also varied greatly within the high-risk groups; the highest prevalence of antibody was seen among surgical house officers (15%). The rate of acceptance of vaccine among hospitals ranged from 57.5% to 23.7%. Reasons for vaccine non-acceptance included fear of as yet unknown side effects, perceived low risk of hepatitis acquisition and possible effects on present or future pregnancies. Our experience illustrates some of the epidemiologic and practical aspects that must be addressed in administering a hospital-based HBV vaccine program. Among the five hospitals, we saw marked inter- and intra-hospital variations in the prevalence of anti-HBs among high-risk employees. More significantly, we observed unexpectedly low rates of vaccine acceptance among high-risk personnel.

Attitude of Health Personnel↗
PubMed1983

Evaluation of daily meatal care with poly-antibiotic ointment in prevention of urinary catheter-associated bacteriuria.

Meatal care with a poly-antibiotic ointment twice daily was evaluated in a prospective, randomized, controlled study of patients with temporary indwelling urethral catheters. Bacteriuria was acquired in 14 of 214 patients treated (6.5 per cent), compared to 16 of 214 patients not given treatment (7.5 per cent). The rate of bacteriuria was slightly lower in the treated than in the untreated group by each of 4 different statistical methods. In a subset of female patients at high risk a significant reduction in the rate of bacteriuria in treated patients was found by 1 method of analysis. These results contrast to previous studies in our hospital in which meatal care, using either nonantiseptic soap and water or an iodophor solution and ointment, was found to predispose to bacteriuria in high risk female patients. The benefit, if any, of meatal care with poly-antibiotic ointment appears to be small.

Administration, Topical↗
PubMed1981

Infections among patients in nursing homes: policies, prevalence, problems.

We performed one-day surveys in seven skilled-care nursing homes in order to evaluate their infection-control policies and to determine the prevalence of infections among their residents. Infection-control programs were not well developed at any of the home surveyed. We noted high patient-to-staff ratios, staffing by nonprofessional personnel, frequent job turnover, infrequent compensation for employee sick leave, and no general policies on immunization of patients or staff. The prevalence of infections among 532 patients was 16.2 per cent. Infected decubitus ulcers, conjunctivitis, symptomatic urinary-tract infections, and lower-respiratory tract infections were the most common types. Eight-five per cent of patients with indwelling urinary catheters had asymptomatic bacteriuria; many were colonized with antibiotic-resistant bacteria. Clustering of cases of upper-respiratory tract infections, diarrhea, conjunctivitis, and specific types of bacteriuria suggested that localized out-breaks of infectious occurred frequently. The high prevalence of infectious diseases and clustering of cases may reflect an increased susceptibility of patients in nursing homes to infections, high employee turnover, or lack of attention to infection-control practices.

Aged↗
PubMed1981

Prevention of catheter-associated urinary tract infections. Efficacy of daily meatal care regimens.

To evaluate the efficacy of daily cleansing of the urethral meatus-catheter junction in preventing bacteriuria during closed urinary drainage, randomized, controlled trials of two widely recommended regimens for meatal care were completed. In 32 (16.0 percent) of 200 patients given twice daily applications of a povidone-iodine solution and ointment bacteriuria was acquired, as compared with 24 (12.4 percent) of 194 patients not given this treatment. In 28 (12.2 percent) of 229 patients given once daily meatal cleansing with a nonantiseptic solution of green soap and water bacteriuria was acquired, as compared with 18 (8.1 percent) of 23 patients not given special meatal care. There was no evidence in either trial of a beneficial effect of meatal care. Moreover, each of four different statistical methods indicated that the rates of bacteriuria were higher in the treated groups than in the untreated groups. In subsets of female patients at high risk in both studies significantly higher rates of bacteriuria were noted in the treated groups than in the untreated groups. Current methods of meatal care appear to be hazardous, as well as expensive, and cannot be recommended as measures to control infection.

Administration, Topical↗
PubMed1981

Risk factors for postoperative pneumonia.

Prospectively studied were 520 patients undergoing elective thoracic, upper abdominal and lower abdominal surgeries to analyze risk factors for postoperative pneumonias. Over-all, pneumonias developed in 91 of the 520 patients studied (17.5 percent). The acquisition of pneumonia was highly associated with preoperative markers of the severity of underlying diseases such as low serum albumin concentrations on admission (P less than 0.005) and high American Society of Anesthesiologists pre-anesthesia physical status classification (P less than 0.0001). History of smoking (P less than 0.001), longer preoperative stays (P less than 0.0001), longer operative procedures (P less than 0.0001) and thoracic or upper abdominal sites of surgery (P less than 0.0001) were also significant risk factors for postoperative pneumonias. Although massive obesity, old age and male sex were also associated with increased incidences of pneumonia, statistical significance was lost when these variables were controlled for site or duration of surgery. We were able to identify risk factors for pneumonia and to define a subpopulation of patients in which the risk of pneumonia was negligible. The acquisition of pneumonia by a low-risk patient should alert the physician to the possibility of a potentially preventable nosocomial infection.

Adult↗
PubMed1981

Failure of bacterial filters to reduce the incidence of pneumonia after inhalation anesthesia.

The authors prospectively studied 520 patients undergoing inhalation anesthesia to evaluate the efficacy of low resistance 0.22-micron bacterial filters in preventing postoperative pneumonias. Patients undergoing elective thoracic, upper abdominal and lower abdominal surgeries were randomly assigned preoperatively to filtered and nonfiltered anesthesia circuits by a study nurse. A second study nurse, who was unaware of patient assignments, followed each patient for five postoperative days to identify possible pulmonary complications. Both groups of patients were similar in age, sex distribution, smoking history, prior pulmonary disease, types and duration of surgery, ASA physical status classification, and receipt of intraoperative antibiotics. No differences in rates of postoperative pneumonia were observed between patients assigned to filtered and nonfiltered circuits (16.7 per cent vs. 18.3 per cent, respectively, P = 0.73). Also no differences were observed when the incidences of other outcome criteria such as postoperative fever, abnormal chest x-ray, sputum production, or abnormal pulmonary physical exam findings were evaluated. The results suggest that bacterial gas filters do not influence the incidence of postoperative pneumonias and that routine use of these devices for this purpose is not cost-effective.

Anesthesia, Inhalation↗
PubMed1980

Membrane filter contact technique for bacteriological sampling of moist surfaces.

We used a membrane filter contact technique to pick up and grow bacteria from artificially contaminated surfaces. We were able to recover individual colony-forming units (CFU) of Staphylococcus aureus from a moist agar surface more efficiently with 3- and 5- micron membrane filters than with Rodac plates, velvet pads, velveteen pads, or smaller-pore membrane filters. The effective transfer of bacteria with the 3- and 5-micron membrane filters was 0.96 +/- 0.04 (standard error of the mean) and 0.99 +/- 0.04, respectively, as compared to 0.49 +/- 0.03 for Rodac plates, 0.09 +/- 0.01 velvet pad imprints, 0.05 +/- 0.01 for velveteen pad imprints, 0.27 +/- 0.02 for velvet pad rinses, 0.005 +/- 0.001 for velveteen pad rinses, 0.39 +/- 0.02 for 0.45-micron filters, and 0.85 +/-0.05 for 1.2 micron filters. In addition, the recovery of S. aureus from contaminated bovine muscle surfaces with the 5-microns membrane filter was similar to that of quantitative dilutions of biopsy material and was significantly higher than the recovery from Rodac plates. The 5-microns membrane filters on a paddle recovered 52 +/- 5 CFU/cm2 from artificially contaminated bovine skeletal muscle, the quantitative dilutions of biopsy recovered 69 +/- 5 CFU/cm2, and the Rodac plate recovered 5 +/- 3 CFU/cm2. Sampling of moist surfaces by the membrane filter contact technique is easy to perform and highly efficient; our data suggest that it could be employed for cultures of clinical surfaces such as surgical wounds or burns.

Agar↗