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Biomedical subjects

R G Finch

Publications and source records attributed to R G Finch.

At least 91 records · Page 5Linked to original sources
PubMed1986

A prospective study of the mechanisms of infection associated with hemodialysis catheters.

Seventy-four subclavian hemodialysis catheters inserted into 53 patients were studied prospectively. Sixteen of 64 assessable catheterization periods were complicated by clinically documented catheter-related sepsis, and 13 had an associated bacteremia. One patient died from catheter-related sepsis, and in two others, sepsis contributed to death. Staphylococci accounted for 11 bacteremias. Semiquantitative culture of the catheters indicated that 28 were significantly colonized. Comparison of these isolates with skin cultures from the insertion site suggested that the origin of the colonizing organisms was the skin (10 cases), intralumenal contamination (16 cases), or both routes (2 cases). Comparison of cultures taken during catheter insertion with those at removal rarely suggested that organisms introduced at insertion caused subsequent colonization. This study has demonstrated that infectious complications from using subclavian hemodialysis catheters exceed reported rates for all other modes of vascular access used for hemodialysis, as well as other indications for central venous catheterization.

Bacteria↗
PubMed1986

Pharmacokinetic studies of imipenem/cilastatin in elderly patients.

Six patients, aged between 68 and 83 years, with glomerular filtration rates (GFR) between 31 and 80 ml/min received imipenem/cilastatin as treatment for acute lower respiratory tract infection. A combination of 500 mg of both agents was administered, 6-hourly, intravenously over 30 min. After a minimum of four doses, blood specimens were obtained for assay of imipenem and cilastatin concentrations by HPLC. Pharmacokinetic parameters were calculated from the results. The mean half life was 1.6 h for imipenem and 2.1 h for cilastatin, values similar to those reported for patients with moderate renal impairment. Elimination constant, clearance and AUC significantly correlated with GFR but not with age. No accumulation was observed.

Age Factors↗
PubMed1986

Characterisation and antibiotic susceptibilities of Streptobacillus moniliformis.

The characteristics of seven strains of Streptobacillus moniliformis, including four isolates from a recent outbreak of Haverhill fever, are reported. Acid production from carbohydrates was uniform apart from variable reactions with mannose and salicin. Enzymatic reactions determined by the API ZYM system and fatty-acid profiles were generally consistent and may be of value in the rapid identification of S. moniliformis. Penicillin was the most active of the antibiotics tested in vitro, which supports its use as the drug of choice in the treatment of Haverhill fever.

Acids↗
PubMed1986

The effect of an antibiotic policy on bacterial resistance in patients in geriatric medical wards.

In an effort to reduce levels of trimethoprim resistance amongst urinary isolates and faecal organisms two antibiotic policies (policy 1, erythromycin, nitrofurantoin substituted for trimethoprim and ampicillin; policy 2, Augmentin (ampicillin + clavulinic acid) substituted for trimethoprim and ampicillin) were used for 50 weeks on two geriatric acute/rehabilitation wards. The policies were evaluated by comparison with the pre-policy period and between policies. The policies were applied successfully and both were associated with a fall in the proportion of trimethoprim-resistant faecal coliforms and urinary isolates. Policy 1 appeared to affect plasmid-mediated resistance to a greater extent than policy 2. There were no differences in outcome for patients during policy periods. Control of antibiotic usage by formal policies is a viable means of controlling bacterial resistance in geriatric wards. The mode of action of such policies requires further elucidation.

Aged↗
PubMed1985

Laboratory studies on coagulase-negative staphylococci from CAPD-associated peritonitis.

This study compared the static and kinetic activities, in both broth and used-dialysate, of selected antibiotics against 23 strains of coagulase-negative staphylococci causing peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). Vancomycin was shown to be effective against all isolates with similar rates of kill to flucloxacillin and cefuroxime, although a few strains were found to be resistant to cefuroxime. Gentamicin was rapidly bactericidal for sensitive strains which accounted for 60% of the strains tested. Fusidic acid was associated with significant resistance and lack of bactericidal activity in the kinetic studies. Emergence of resistance occurred with rifampicin. The combinations clavulanic acid/amoxycillin and sulbactam/ampicillin generally showed good static activity. In addition a broad range of biotypes and phage types were demonstrated among these organisms with biotype SII (Staphylococcus epidermidis) predominating. There was no correlation between biotype and antibiogram.

Anti-Bacterial Agents↗
PubMed1985

A morphological study of bacterial colonisation of intravenous cannulae.

In an investigation of bacterial colonisation of intravascular cannulae, 16 peripheral venous cannulae of the Venflon variety and 24 chronic haemodialysis cannulae were studied after removal from patients. Studies of colonisation included semi-quantitative microbiological culture and scanning electronmicrographic (SEM) observations. The microbiological findings indicated colonisation of the intravascular portion of the catheter in 4 of 16 Venflon cannulae and 18 of 26 haemodialysis cannulae, largely with skin commensal organisms. The results of the SEM studies were in broad agreement with the microbiological observations. Surface defects on the cannulae were shown to be associated with microbial colonisation which occurred either as isolated colonies or in association with a cellular fibrinous matrix. These observations are illustrated and discussed.

Bacillus↗
PubMed1985

A case of herpes zoster associated encephalitis with rapid response to acyclovir.

A case of herpes zoster encephalitis which responded very rapidly to acyclovir is presented. The differential serum: cerebrospinal fluid antibody response was followed and its value in making the diagnosis is discussed. The penetration of acyclovir into the cerebrospinal fluid was measured, and found to be in agreement with predicted values.

Acyclovir↗
PubMed1985

Studies on the microbiological safety of the valved side-port of the 'Venflon' cannula.

A randomized prospective study was conducted to assess the effect of inserting a bacteria-retaining filter into the side-port of 'Venflon' cannulae. Observations were made on 109 cannulae with filters and 100 without. Although there was a trend towards a reduced rate of side-port colonization in the cannulae with filters this was not paralleled by any reduction in the incidence of local inflammation or colonization of the intravascular segment (IVS) of the cannula. Of the 37 cannulae with positive cultures from the skin at the cannula insertion site 22 yielded indistinguishable bacteria from the IVS, while only three of the 25 positive side-port cultures were similarly associated. It is concluded that in the majority of cases, organisms isolated from the IVS originate on the skin and that organisms introduced via the side-port rarely lead to IVS colonization.

Catheterization↗
PubMed1985

The management of splenic abscess.

We report three patients with splenic abscess whom we attempted to treat without recourse to open surgery. Medical treatment alone was successful in one case, and medical treatment combined with percutaneous drainage was successful in the second. Splenectomy was required in the third case after failure of medical treatment and complications of percutaneous drainage. The difficulties in diagnosing splenic abscess are reviewed and the indications for splenectomy or percutaneous drainage, as opposed to medical treatment are considered.

Abscess↗
PubMed1984

Group G streptococcal septicaemia: clinical observations and laboratory studies.

The clinical features of Group G streptococcal bacteraemia in nine patients are reported. The serious nature of many of these infections was striking, with major embolic complications in all three patients with endocarditis. In this hospital, Group G streptococcal bacteraemia is now more common than that caused by Streptococcus pyogenes. Laboratory investigations included serotyping and antimicrobial susceptibility testing. Although the strains isolated were found to be sensitive to a broad range of agents, tolerance was observed to a varying extent with penicillin, erythromycin and vancomycin. The clinical significance of this observation remains to be determined.

Aged↗
PubMed1984

The complications of intravenous cannulae incorporating a valved injection side port.

In a series of 519 intravenous cannulae with valved injection side-ports the incidence of cannula-related local inflammation was 25.2% and bacteraemia 0.2%. Severe local inflammation was associated with a longer mean duration of cannulation, 59.4 v. 81.4 h (P = less than 0.05). There was no significant association between the presence of local inflammation and microbial colonization of either the intravascular segment of the cannula, the adjacent skin, or the side-port. The data suggest that colonization of the cannulae was usually secondary to prior skin colonization. Side-port colonization did not predispose to cannula colonization. Organisms colonizing the side-port were biologically different and were possibly derived from the skin of medical attendants. In the final 157 patients, randomized to receive either isopropyl alcohol or 0.5% chlorhexidine in 70% spirit skin preparation, there was no difference in the incidence of either local inflammation or microbial colonization.

Catheterization↗
PubMed1984

The use of injectable antibiotics in two general hospitals.

Injectable antibiotic use in Nottingham has shown a change in the past 3 years: the quantity of cefotaxime and cefuroxime prescribed by the end of 1983 was double that of aminoglycosides. The majority (69%) of use of the newer cephalosporins is for prophylaxis. This significant increase in use of cephalosporins has not been accompanied by an increase in bacterial resistance to cefuroxime or cefotaxime. However, these two agents cause the majority of toxin-positive antibiotic-associated diarrhoea in Nottingham hospitals.

Anti-Bacterial Agents↗
PubMed1983

Streptobacillus moniliformis isolated from blood in four cases of Haverhill fever.

During February, 1983, an outbreak of an unusual febrile illness occurred in over 130 children attending a boarding school in Chelmsford, Essex. The clinical features included fever, an erythematous rash that was most prominent on the hands and feet, arthralgia, and the subsequent development of a sore throat. The nature and distribution of the rash varied considerably between patients and at different stages of illness. At first a viral aetiology was regarded as most likely. When Streptobacillus moniliformis was later isolated from the blood of 4 of the patients with moderately severe illnesses it became apparent that an outbreak of Haverhill fever had occurred at this school. The most probable source of the outbreak was raw milk, since all 4 patients had consumed raw milk at the school shortly before the onset of symptoms and there was no evidence of person-to-person spread of infection.

Adolescent↗
PubMed1983

Erythromycin compared with a combination of ampicillin and amoxycillin as initial therapy for adults with pneumonia including Legionnaires' disease.

In a double blind trial erythromycin was compared with a combination of ampicillin and amoxycillin for treating adults admitted to hospital with primary pneumonia. The clinical course of 42 patients treated with ampicillin and amoxycillin was similar to that of the 49 in the erythromycin group. Fall in temperature, symptomatic recovery and radiographic improvement were similar (two-thirds made an uncomplicated recovery). Infusion-related phlebitis was more common with erythromycin. Otherwise adverse reactions were unusual. The outcome was related principally to the cause of the pneumonia with bacteraemic/antigenaemic pneumococcal pneumonia, Legionnaires' disease, other bacterial pneumonias and psittacosis having a poor prognosis. Both forms of antibiotic therapy gave similar results but we suggest that a combination of erythromycin with ampicillin may be logical initial treatment for severe pneumonia of unknown cause.

Adult↗
PubMed1982

Hospital study of adult community-acquired pneumonia.

The cause of primary pneumonia was diagnosed in 124 of 127 consecutive adult patients admitted to hospital with community-acquired illness. Pneumococcal infection was found in 96 (76%) patients and legionnaries' disease was the second commonest infection identified (15%). Other bacterial infections were uncommon. 11 patients had atypical pneumonia, including 7 with psittacosis. There were several mixed infections and most of the 11 patients with viral infections also had bacterial pneumonia. 19 patients died (15%) and mortality was associated with increasing age, the presence of coexisting disease, and the cause of the pneumonia. Recognition of the most likely causes of severe pneumonia allows logical initial antibiotic treatment for such patients admitted to hospital.

Adolescent↗