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Biomedical subjects

R Fekety

Publications and source records attributed to R Fekety.

At least 55 records · Page 3Linked to original sources
PubMed1983

Comparison of methods for recovery of Clostridium difficile from an environmental surface.

Survival of Clostridium difficile in an aerobic environment is possible because of spore formation. When sodium taurocholate is substituted for the egg yolk of a selective medium, cycloserine-cefoxitin-fructose-agar (CCFA), enhanced recovery of C. difficile spores is shown. This selective medium (TCCFA) does not improve recovery of vegetative forms. In this study, dry and saline-moistened swabs, adhesive paddles, and Rodac plates containing CCFA and TCCFA were compared in their ability to recover C. difficile spores from an inoculated surface. Rodac plates grew 20 to 25 times as many spores on TCCFA as on CCFA. Saline-moistened swabs recovered fewer organisms than Rodac plates. Dry swabs and adhesive paddles rarely recovered spores. Prereduction of agar in an anaerobic chamber was not necessary for optimal spore recovery. Optimal growth of vegetative C. difficile required prereduced media. Agar prereduced for 2 h supported the growth of 12 C. difficile isolates as well as agar prereduced for 18 h. Vegetative cells of C. difficile survived for only 15 min in room air. Use of Rodac plates containing TCCFA is preferred for detection of C. difficile spores in the hospital environment.

Agar↗
PubMed1983

Antibiotic-associated colitis due to Clostridium difficile in a Kodiak bear.

Clostridium difficile and its toxins usually are present in feces of laboratory animals and persons with antibiotic-associated colitis. We report antibiotic-associated colitis in a captive Kodiak bear (Alaskan brown bear, Ursus arctos) in which C difficile and its cytotoxin were found in feces. This indicates that the colitis associated with C difficile and its toxins can occur in nonlaboratory large animals and that this organism may be the causative agent in certain cases of idiopathic colitis in animals. This case also indicates that nonlaboratory animals may be a source of the organism.

Animals↗
PubMed1982

Vancomycin.

While vancomycin is thus not as nephrotoxic as once feared, its use by the parenteral route should be avoided if possible when other nephrotoxic drugs are being given. Used properly, vancomycin appears efficacious and can be given with safety to infants, children, and adults. Vancomycin is incompatible with many other drugs in intravenous solutions, especially chloramphenicol, adrenocorticosteroids, and methicillin.

Bacteria↗
PubMed1982

Antibiotic-associated pseudomembranous colitis: an epidemiologic investigation of a cluster of cases.

Ten cases of antibiotic-associated colitis (AAC) were identified at a hospital in Washington, D.C., from March 17 to May 9, 1979. No geographic clustering of cases was found, nor was an association with increased use of antibiotics demonstrated. Exposure to aminoglycosides, cephalosporins, and clindamycin was associated with AAC, as was a history of enemas in the seven days before the onset of illness (P=0.045). This association was strengthened when gastrointestinal procedures-defined as (1) three or more enemas per week, (2) the insertion of a nasogastric tube for two or more days, or (3) gastrointestinal surgery-were performed within seven days of the onset of illness (P=0.007). Clostridium difficile was not isolated from the hospital environments, nursing personnel, or family members of the patients. C. difficile was isolated from stool specimens of five (36%) of 14 patients who served as controls.

Adult↗
PubMed1982

Clostridium difficile colitis associated with cancer chemotherapy.

Administration of cancer chemotherapeutic agents to humans and animals is frequently complicated by diarrhea and enterocolitis. Clostridium difficile and its toxin were found in the stools of two patients with colitis after chemotherapy for malignant neoplasms. Diarrhea in both patients resolved with oral vancomycin hydrochloride therapy. Clostridium difficile was also isolated from several fomites within the room of one of these patients and also from the hands of his nurses. Based on these two recent experiences, we believe patients with cancer and diarrhea or signs suggestive of colitis should be studied for toxigenic C difficile and appropriate isolation techniques employed.

Adenocarcinoma↗
PubMed1981

Treatment of Clostridium difficile colitis and diarrhea with vancomycin.

Toxigenic Clostridium difficle is the major cause of antibiotic-associated colitis and is susceptible to vancomycin at fecal concentrations achieved with oral therapy. The effect of oral vancomycin was studied in 16 patients with C. difficile-related diarrhea or colitis, 12 of whom had colitis documented by endoscopy, biopsy, and/or barium enema. Four patients had antibiotic-associated diarrhea and possibly antibiotic-associated colitis, because sigmoidoscopy either showed normal results (two patients) or was not performed (two patients). Nineteen episodes of diarrhea were treated with oral vancomycin in two dosage regimens for three to 14 days. Twelve patients received 2 g daily, and four patients initially received 1 g or less per day. Within 48 hours of the start of vancomycin therapy, 14 of 16 patients (87 percent) showed a decrease in temperature, abdominal pain and diarrhea. Diarrhea ceased completely within two days of the start of vancomycin in nine episodes, within three to seven days in six episodes, and within eight to 14 days in the remaining four episodes, and within eight to 14 days in the remaining four episodes. Diarrhea recurred in two of these patients (12 percent) when the drug inciting the initial episode of colitis was given again 42 days or more after vancomycin therapy was stopped; both patients responded again to retreatment with vancomycin. Oral vancomycin is an effective treatment of C. difficile-related colitis and diarrhea.

Adolescent↗
PubMed1981

Epidemiology of antibiotic-associated colitis; isolation of Clostridium difficile from the hospital environment.

Clostridium difficile is the most important cause of antibiotic-associated colitis. Using selective media, it was found that contamination with this organism was common in the environment of patients in the hospital with the disease. It was often found on floors, hoppers, toilets, bedding, mops, scales and furniture. This organism was also present on these items, but less often, in areas in which patients known to carry this hardy spore-forming organism had not been detected. Air, food and walls were negative. The organism was isolated from the hands and stools of asymptomatic hospital personnel. It was also found on surfaces in a patient's home. The importance of the various sources of the organism in its spread in the hospital is not known, and further studies are needed. It is suggested that enteric isolation precautions, and careful handwashing and cleansing of potentially contaminated surfaces and objects may be worthwhile when cases of antibiotic-associated colitis are identified.

Anti-Bacterial Agents↗
PubMed1981

Prevention and treatment of viral infections: problems and current recommendations.

Childhood immunization unfortunately has ceased to be an important focus of preventive medicine in the United States. Although smallpox is no longer a problem, vaccination against poliomyelitis, measles, and rubella is still very much needed. Immunization is also available for hepatitis B, influenza, and rabies and can be carried out in children or adults under selected circumstances. The antiviral drugs now being used have limited roles, although new drugs on the horizon seem promising.

Adolescent↗
PubMed1981

Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis.

Clostridium difficile is the most important cause of antibiotic-associated colitis, but its epidemiology remains unknown. Using a selective medium for the isolation of C. difficile, cultures were obtained from the environment and contacts of hospitalized patients carrying C. difficile in their stools. In areas where carriers had diarrhea, 85 (9.3%) of 910 cultures of floors and other surfaces, especially those subject to fecal contamination, were positive. In areas where there were no known carriers, only 13 (2.6%) of 497 cultures of similar sites were positive (P less than 0.005). C difficile was isolated from hands and stools of asymptomatic hospital personnel, from sewage and soil, and from the home of a patient. Environmental isolates were toxigenic. C. difficile inoculated onto a floor persisted there for five months. Further studies are needed to document how often floor persisted there for five months. Further studies are needed to document how often C. difficile shed by patients with antibiotic-associated colitis is acquired by other persons and whether isolation precautions are capable of limiting the organism's spread.

Anti-Bacterial Agents↗
PubMed1981

Studies on the epidemiology of colitis due to Clostridium difficile in hamsters.

Hamsters treated with vancomycin developed enterocolitis significantly more often in a conventional animal room than in a room designed to prevent cross-infection with Clostridium difficile. In the conventional room C. difficile was isolated from cages, food racks, floors, buckets, the hands of caretakers, and the stools of animals with enterocolitis but not from untreated hamsters, air, or food from freshly opened bags. C. difficile was not isolated from environmental sources in the clean room. It was not possible to determine which of the sources of the organism was most important in its spread. Cross-infection with C. difficile may be important in the pathogenesis of antibiotic-associated enterocolitis in hamster colonies.

Animals↗
PubMed1981

Evaluation of eight cephalosporins in hamster colitis model.

Eight commonly used cephalosporins were evaluated in the hamster colitis mode. They were all found to cause hemorrhagic cecitis and death within 10 days of being given as subcutaneous or oral challenges. Necropsy findings were indistinguishable from clindamycin-induced cecitis. Bacteria-free cecal filtrate obtained from hamsters dying of cephalosporin-induced cecitis contained toxin similar or identical to hat produced by Clostridium difficile isolated from the cecum of a hamster. Daily oral administration of poorly absorbed cephalosporins protected hamsters from clindamycin-induced cecitis and death as long as the cephalosporins were continued. The absorbable cephalosporins were ineffective in protecting hamsters from clindamycin-induced cecitis. This difference probably relates to the lower concentrations of absorbable cephalosporins maintained in the ceca of the hamsters. The possible correlation of these findings to human cases of cephalosporin-induced pseudomembranous colitis is discussed.

Animals↗
PubMed1980

Office treatment of infection. 1. Respiratory infections.

Viral infections of the respiratory tract are more common but less easily treated than bacterial infections. Knowledge of the current patterns of susceptibility of the most common bacterial agents helps in selecting therapy. Many infections can be treated in the office empirically, provided adequate follow-up is assured.

Adult↗
PubMed1980

Studies on the epidemiology of antibiotic-associated Clostridium difficile colitis.

Vancomycin protects hamsters from the development of Clostridium difficile colitis after treatment with clindamycin, and vancomycin is useful in treatment of humans with the disease. Relapses have occurred in both hamsters and humans when vancomycin is discontinued. Vancomycin appears to enhance susceptibility to colonization with C. difficile by eliminating competing intestinal organisms. The nature of these organisms is not known, but various tools are now available to aid in identifying them. Cancer chemotherapeutic agents should be added to the list of factors such as surgery and antibiotics that may predispose to emergence of C. difficile. The number of organisms required for colonization of antibiotic-treated hamsters is low and cross-infection seems to play a role in the disease in hamster colonies. The organism can be detected on surfaces in rooms of patients with the disease, and on the hands of personnel caring for them. Outbreaks of the disease have been recognized. Our results suggest isolation precautions should be used to prevent spread of the organism from patients with the disease to others being treated with antibiotics.

Animals↗