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Biomedical subjects

R Quintiliani

Publications and source records attributed to R Quintiliani.

At least 217 records · Page 12Linked to original sources
PubMed1978

Evaluation of an oral prolonged-release antibiotic formulation.

The antibiotic cephalexin was formulated as an oral prolonged-release tablet and evaluated by in vitro dissolution testing as well as in vivo in 10 human subjects. Comparisons were made of the time course of the blood levels among the prolonged-release formulation, the commercially available capsule, and intravenous administration. Even though lower peak blood levels were attained in the prolonged-release tablet, absorption continued for at least 6 hr. Comparison with in vitro dissolution data showed that absorption was dissolution rate limited. Bioavailability comparisons showed that the prolonged-release formulation was completely available, as was the commercial oral capsule.

Administration, Oral↗
PubMed1978

Aminoglycoside antibiotics moderately impair granulocyte function.

By in vitro methods, five aminoglycoside antibiotics (amikacin, kanamycin, gentamicin, tobramycin, and netilmicin) were shown to produce modest changes in granulocyte adherence (increase) and migration (decrease) and no change in phagocytosis or nitroblue tetrazolium reduction.

Amikacin↗
PubMed1978

Flavobacterium meningosepticum meningitis: report of selected aspects.

Two patients developed meningitis due to Flavobacterium meningosepticum. Because of resistance to most available antimicrobial agents, intravenous and intraventricular erythromycin was administered to one patient. Subsequent development of resistance to erythromycin prompted the use of intravenous and intraventricular rifamycin, which eventually resulted in cure. Diagnosis of F. meningosepticum meningitis in the second patient was delayed, and appropriate therapy was not administered until 4 days prior to the patient's death. Of 82 previously published cases, only 4 occurred in adults. Therapy of meningitis due to this organism has been a difficult problem, and we suggest possible modes of therapy, based on our experience and a review of the literature.

Aged↗
PubMed1978

Bacteraemia after manipulation of the urinary tract. The importance of pre-existing urinary tract disease and compromised host defences.

The factors related to the occurrence of bacteraemia following urinary tract manipulation were studied in a large community hospital. During a 3-year period, forty-six of 326 episodes of hospital-acquired bacteraemia were associated with urinary tract manipulation. All thirty of forty-six cases felt to be definitely related to urinary tract manipulation (other obvious sources of bacteraemia being absent) had pre-existing urinary tract disease, especially of an obstructive type; only one in this group died from sepsis. The remaining sixteen patients had other possible sources of bacteraemia besides urinary tract manipulation and had disorders associated with defects in host defences; twelve (75%) in this group died from overwhelming sepsis. Thus, if bacteraemia occurs in a patient having had urinary tract manipulation but without any underlying urinary tract abnormality or impairment in host defences, its source should be searched for in other areas of the body.

Bacteriuria↗
PubMed1978

Failure of disposable domes to prevent septicemia acquired from contaminated pressure transducers.

Between January and June 1976, eight cases of primary bacteremia due to Enterobacter cloacae occurred in patients after open-heart surgery in a hospital in Connecticut. Epidemiologic studies implicated radial arterial catheters as the route of acquistion of E cloacae, and bacteriologic studies confirmed arterial pressure transducers as the sources of bacteria. Prospective studies indicated that the disposable domes from the pressure transducers did not prevent the spread of bacteria from contaminated transducers to the arterial catheters. This is the first report of transducer-acquired bacteremic infections occurring with the use of disposable domes. Although disposable domes may decrease the chances of cross-contamination of circuits for monitoring pressure, they do not, as previously thought, eliminate the risk of bacteremia from this source.

Blood Pressure↗
PubMed1978

Cefazolin.

After 5 years of use, cefazolin can be considered similar to cephalothin as a therapeutic agent and in its potential for adverse reactions. When cefazolin and cephalothin are compared by appropriately designed clinical trials, neither cefazolin's slightly greater in-vitro susceptibility to staphylococcal beta-lactamase inactivation, nor its slightly greater microbiologic activity for some enterobacteraciae has been shown to result in any readily apparent therapeutic differences. The important differences between cefazolin and cephalothin--and this is also probably true with respect to cephapirin and cephradine--are not in therapeutic effectiveness, microbiologic activity, or toxicity but rather in pharmacokinetics and cost-effectiveness.

Agranulocytosis↗
PubMed1978

Prediction of gentamicin serum levels using a one-compartment open linear pharmacokinetic model.

The accuracy of predicting serum gentamicin levels based on a one-compartment open linear pharmacokinetic model was studied. Twenty-two patients accounted for 59 serum gentamicin levels which were measured by microbiologic assay and compared with predicted serum levels determined by pharmacokinetic calculation. Seventeen serum levels were collected at peak times, 15 at trough time and 27 at times between peak and trough. Forty-nine of the levels were obtained from patients with impaired renal function. Predicated gentamicin levels correlated well with measured serum levels (r = 0.85, p less than 0.001). Of the measured levels, 56% were within +/- 1 microgram/ml of the predicted levels. Of 49 levels collected from patients with impaired renal function, 59% were within +/- 1 microgram/ml of the predicted level. In 13 patients from whom multiple serum gentamicin levels were collected and predictions based on half-life or elimination rate obtained by fitting the first level, 83% of the measured levels were within +/- 1 microgram/ml of the predicted level. The one-compartment open linear pharmacokinetic calculations can be used to adequately predict serum gentamicin levels. In patients with changing or diminished renal function, pharmacokinetic predictions may not be accurate, and actual serum level determinations may be needed to monitor gentamicin therapy.

Adult↗
PubMed1977

Comparison of concentrations of amoxicillin and ampicillin in serum and middle ear fluid of children with chronic otitis media.

Twenty-eight children aged five to nine years with chronic serous otitis media received a single dose of either ampicillin or amoxicillin by the oral route 1-2 hr before the removal of middle ear fluid by ventilation tubes inserted through the tympanic membrane. At the time middle ear fluid was obtained, a sample of blood was drawn from the patient, and levels of antibiotic in both specimens were microbiologically assayed by a disk diffusion method. Levels of amoxicillin (mean+/-standard error [SE], 1.48+/-1.6 microng/ml) in middle ear fluid were consistently and significantly higher (P less than 0.05) than levels of ampicillin (mean+/-SE, 6.2+/-5.0 microng/ml).

Administration, Oral↗
PubMed1977

Myocardial dysfunction and hemolytic anemia in a patient with Mycoplasma pneumoniae infection.

A patient with evidence of myocardial abnormalities and hemolytic anemia is described, in whom the responsible pathogen appeared to be Mycoplasma pneumoniae (as indicated by a 64-fold rise in complement-fixation titers, and by a change in cold-agglutinin titers from 1:8 to 1:4,096). Both cardiac and hematologic problems occurred during the recovery phase from pneumonia and were associated with marked deterioration in the patient's clinical status. Electrocardiographic and serum enzymatic changes mimicked the patterns seen in acute myocardial infarction.

Adult↗
PubMed1977

Non-pneumococcal Gram-positive coccal meningitis related to neurosurgery.

Thirty-eight of 154 cases (25%) of bacterial meningitis seen by the authors during a 7-year period were due to non-pneumococcal Gram-positive cocci. Thirty cases (80%) resulted from neurosurgical manipulation; half of these were shunt infections and half were early postoperative complications. Only three cases (8%) occurred de novo in patients with presumably normal host defenses. Signs, symptoms, and laboratory data related more to predisposing factors than to infecting microorganisms. Fever, peripheral leukocytosis, abnormal cerebrospinal fluid (CSF), and positive Gram stain were the most reliable indicators of infection. Prognosis was good with antibiotic therapy and removal of CSF shunt equipment when present.

Adolescent↗
PubMed1977

Partial characterization of a cell-directed inhibitor of leukotaxis in human serum.

A leukotactic defect is described in a man with a low cerebrospinal fluid leukocyte count in the presence of an acute listeria meningitis. On the basis of subsequent studies with his serum and normal human serum, a leukotactic inhibitor has been identified. This inhibitor, termed the cell-directed inhibitor (CDI), is relatively heat stable and nondialyzable. By ultracentrifugal analysis in sucrose density gradient, the inhibitor has been resolved into two activities with estimated sedimentation coefficients of 7 and 10 S. It interacts directly with neutrophils and monocytes to render them chemotactically defective. CDI also impairs the phagocytic function of neutrophils. Evidence is presented that an antagonist to the inhibitor is present in normal serum. CDI and its antagonist are probably normally occurring regulators of leukotaxis. In the patient studied, an elevated CDI serum level may be related to the development of the listeria infection and failure of cutaneous response to skin test antigens.

Cerebrospinal Fluid↗
PubMed1977

Safety and efficacy of combining obstetric and noninfectious gynecologic hospital patients.

Unoccupied obstetric beds and unused delivery rooms represent inefficient use of hospital facilities and loss of revenue, both of which adversely affect the quality of care rendered patients. Hartford Hospital has permitted the admission of obstetric and noninfectious gynecologic patients to the same patient care areas of the hospital as well as use of delivery rooms by both groups of patients. Elaborate surveillance of these patients by the epidemiology section for a 1-year period (July 1974-July 1975) demonstrated no increase in the incidence of hospital-acquired infections associated with this combined approach as compared with the more traditional separation system of maternity and nonmaternity patients.

Connecticut↗
PubMed1977

The penetration characteristics of cefazolin, cephalothin, and cephradine into bone in patients undergoing total hip replacement.

Preoperatively, to prevent infection, seventy-one patients who were to have total hip arthroplasty were given one gram of cephalothin, cephradine, or cefazolin intravenously. Simultaneous samples of bone and serum were obtained after various time intervals and assayed for cephalosporin concentration to correlate the antibiotic concentrations in these sites with time. Of the cephalosporins tested, cefazolin achieved the highest total peak levels in bone (thirty micrograms per gram), followed in descending order by cephradine (twenty-three micrograms per gram) and cephalothin (2.8 micrograms per gram). These peak levels in bone, reached twenty-five to forty minutes after injection, were sixty, 6.7, and fifteen times higher than the usual mean minimum inhibitory concentrations of cefazolin, cephradine, and cephalothin, respectively, for penicillin-resistant staphylococci. The half-lives of the antibiotics in bone were forty-two, forty, and thirty minutes, respectively.

Aged↗
PubMed1976

Clinical, epidemiologic and bacteriologic observations of an outbreak of methicillin-resistant Staphylococcus aureus at a large community hospital.

Over a 12 month period, 61 isolates of methicillin-resistant Staphylococcus aureus (MR-SA) were obtained in 23 hospitalized patients. Eight-six per cent of the patients were over 50 years of age, and 91 per cent were in the postoperative period. In 10 patients (42 per cent), MR-SA was the major pathogen, producing either pneumonia, empyema, osteomyelitis, lung abscess, enterocolitis, wound infection or bacteremia with sepsis. Three patients in this group died despite therapy with antibiotics with in vitro activity against these organisms. All the patients probably acquired their MR-SA in the hospital, and five carriers of the organism were identified among hospital personnel. This outbreak demonstrates the ability of MR-SA not only to colonize many patients in a relatively brief period of time, but also to produce serious disease.

Adult↗
PubMed1976

Synergism of cefazolin-gentamicin against enterococci.

A miniaturized technique for detecting antibiotic synergy by using microliter volumes was perfected. With this microtiter serial dilution method, the effect of the previously untried combination of cefazolin and gentamicin on 10 strains of enterococci was evaluated. At clinically achievable concentrations, the combination of cefazolin and gentamicin was found to be synergistic against all 10 strains when the data were plotted in the form of an isobologram. These results were compared with the conventional method of detecting synergy in vitro, namely, the determination of the rate of killing of the microorganisms with the antibiotics, singly and in combination. Similar results were also observed. These findings indicate that the microtiter serial dilution technique is a useful method for the routine determination of drug synergy. Moreover, in a patient with penicillin hypersensitivity and enterococcal infection, the combination of cefazolin and gentamicin should be considered for possible therapy.

Cefazolin↗
PubMed1976

Fatal case of influenza pneumonia with suprainfection by multiple bacteria and Herpes simplex virus.

A case of influenza pneumonia is described in which death occurred from persistence of the influenza infection and suprainfection with two bacteria, Staphylococcus aureus and Escherichia coli, and another virus, Herpes simplex. Of additional interest were the observations that this overwhelming illness developed in a previously healthy person, that typical influenza virus particles were present in antemortem lung tissue, and that the patient died despite 6 days of extracorporeal membrane oxygenation and corticosteroids.

Adult↗