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Biomedical subjects

S D Lang

Publications and source records attributed to S D Lang.

At least 37 records · Page 2Linked to original sources
PubMed1988

Clinically significant Streptococcus anginosus (Streptococcus milleri) infections: a review of 186 cases.

We describe clinically significant infections due to Streptococcus anginosus in 186 patients; 114 (61.3%) males and 72 (38.7%) females, median age 42 years, range 9 months to 93 years. In 101 (54.3%) cases S anginosus alone caused infection and in 85 (45.7%) cases it was associated with other microorganisms. Abscesses accounted for 110 (59.1%) infections. Sites of infection were: miscellaneous skin and soft tissue, 64 (34.4%), intraabdominal 41 (22%), head and neck 34 (18.3%), pleuropulmonary 22 (11.8%), genitourinary 9 (4.8%), musculoskeletal 6 (3.2%), endocarditis 5 (2.7%) and primary bacteraemia 5 (2.7%). Treatment consisted of antibiotic therapy which was often prolonged, median 30 days, range 2-90 days, and surgery in 159 (85.5%). S anginosus infection was a contributory factor in two of the three deaths which occurred.

Abscess↗
PubMed1988

Prophylaxis in appendicectomy with cefoxitin or ceftriaxone.

Two hundred and forty adults undergoing acute appendicectomy were randomised to receive either cefoxitin or ceftriaxone 1 g intravenously at induction of anaesthesia. Patients were monitored daily while in hospital, and at least 4 weeks after discharge for evidence of wound, urinary or lower respiratory tract infection. We evaluated 167 patients at follow up and found no significant difference in infection rates between the two antibiotic groups. Thirty-four had normal appendices and 1 of 16 (6.3%) given cefoxitin and 2 of 18 (11.1%) given ceftriaxone developed wound infections. Ninety-seven had acute appendicitis and 3 of 48 (6.3%) given cefoxitin and 3 of 49 (6.1%) given ceftriaxone developed infections including 2 wound infections in each group. Thirty-six had gangrenous perforated or abscessed appendices: 31 were given additional antibiotics postoperatively, and 4 of 18 (22.2%) in each prophylactic antibiotic group developed infections, including wound infection in 3 given cefoxitin and in 4 given ceftriaxone. None of the infections were serious. Sixty-one percent presented after discharge from hospital. The mean hospital stay was 4.6 days for each antibiotic group. Neither antibiotic caused adverse effects.

Abscess↗
PubMed1988

An audit of restricted antibiotic use in a general hospital.

An audit of the use of antibiotics restricted by the hospital formulary was undertaken by retrospective analysis of 73 written justifications for prescriptions provided to the pharmacy and the case notes. Half of the prescriptions were for therapeutic indications with the remainder divided almost equally between prophylactic and empirical use. The cost of therapy was $34,500. Antibiotic use was classified as appropriate or inappropriate. Inappropriate use was seen in 22 cases at an excess cost of $3828. Prophylactic use accounted for 13 of the inappropriate prescriptions, most frequently due to excessive duration of prescription. The use of amikacin where gentamicin was not contraindicated was seen in 4 of 9 inappropriate prescriptions. The infrequent use of the more expensive antibiotics and the potentially remediable inappropriate use seen with prophylaxis were gratifying aspects of this audit.

Anti-Bacterial Agents↗
PubMed1988

Wound infection with aerogenic Aeromonas strains: a review of twenty-seven cases.

Aeromonas spp. have been implicated in a wide spectrum of human disease including wound infection. A review is made of local experience of 27 wound infections from which aerogenic strains of Aeromonas were recovered; of these, Aeromonas was isolated in pure culture from five infections. Twenty-five infections were related to trauma and were community acquired, while two were probably nosocomial. Of the 25 community acquired infections, 16 were associated with contamination by soil and one with water. Twenty-six cases were surgically debrided or a limb or digit amputated, but in only one case was amputation performed because of uncontrolled infection. Fifteen patients received antibiotics inappropriate for the infection, yet the outcome was uniformly good. This series is discussed with a review of the English language literature. Aeromonas is most likely to be isolated when there is contamination of a wound by soil or water; adequate surgical debridement is probably of primary importance.

Adult↗
PubMed1986

Comparative in-vitro activity of antibiotics incorporated in acrylic bone cement.

We compared the persistence of antibacterial activity around antibiotic-impregnated acrylic bone cement discs which were serially transferred on seeded agar plates. On plates inoculated with Staphylococcus aureus ATCC 25923, CMW1 discs containing 2.5% by dry weight of cephalothin, coumermycin or fusidic acid (as diethanolamine fusidate) produced zones of inhibition for four to eight weeks when transferred daily. In contrast, ceftriaxone, cotrimoxazole, rifampicin and vancomycin ceased to be inhibitory within a week. Discs made of 'Palacos-R with Garamycin,' which contains gentamicin 1.25%, had an intermediate duration of activity. When Escherichia coli ATCC 25922 was used as the test organism, ceftriaxone and 'Palacos-R with Garamycin' showed activity for almost three weeks, cephalothin and cotrimoxazole were briefly inhibitory and the remainder not at all. When discs were transferred each week instead of daily, the ranking of antibiotics was similar but antibacterial activity persisted for longer. A combination of gentamicin plus fusidic acid in CMW1 was active for a much shorter time than either fusidic acid alone or 'Palacos-R with Garamycin'. We conclude that coumermycin is a promising new agent for incorporation in acrylic cement.

Acrylates↗
PubMed1986

In-vitro activity of coumermycin against methicillin-resistant staphylococci: a comparison with six other agents.

The in-vitro activity of coumermycin was compared with that of vancomycin, rifampicin, fusidic acid, trimethoprim-sulphamethoxazole, norfloxacin and cefamandole against seven isolates of methicillin-resistant Staphylococcus aureus and 97 isolates of methicillin-resistant coagulase negative staphylococci. Apart from one strain of methicillin-resistant S. aureus all isolates were inhibited by less than or equal to 0.06 mg/l of coumermycin. Cefamandole was more active against strains of S. epidermidis than against other coagulase negative staphylococci.

Aminocoumarins↗
PubMed1986

Antimicrobial spectrum of Ro 15-8074/001, a new oral cephalosporin.

The activity of Ro 15-8074/001 was compared with that of cefaclor, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole, norfloxacin, and ceftriaxone against 225 clinical isolates. It was more active than cefaclor, amoxicillin-clavulanic acid, and trimethoprim-sulfamethoxazole against members of the family Enterobacteriaceae and Haemophilus influenzae and had activity similar to that of cefaclor against nonenterococcal streptococci. It was not usefully active against Pseudomonas aeruginosa, Streptococcus faecalis, or most isolates of staphylococci.

Anti-Bacterial Agents↗
PubMed1985

Intravascular cannula-related sepsis: two years experience.

Thirteen episodes of intravascular cannula-related sepsis were seen during a two year period. Staphylococcus aureus was the most common pathogen. Fungaemia occurred in four patients all receiving total parenteral nutrition. Culture of the cannula tip and swabs of the insertion site were useful in confirming the diagnosis. Three patients with infection due to S aureus died while receiving treatment for their infections. Care with insertion and maintenance of intravascular cannulae should reduce the frequency of this iatrogenic infection.

Aged↗
PubMed1985

Catheter-related sepsis in patients on intravenous nutrition: a prospective study of quantitative catheter cultures and guidewire changes for suspected sepsis.

One hundred and ninety-five central venous catheters used for intravenous nutrition in 113 patients were studied prospectively. Catheter-related sepsis (CRS), defined by recovery of the same organism from the catheter tip and peripheral blood cultures, occurred with only 3.3 per cent of catheters or 2.3 per 1000 days of therapy. In contrast, CRS was suspected with 30 per cent of catheters and catheter contamination occurred in 37 per cent. Contamination was defined by a positive catheter tip culture without recovery of the same organism from the blood. CRS was present in 4 of 12 cases (33 per cent) with greater than 1000 colony forming units on the catheter tip but in only 2 of 54 (4 per cent) with fewer organisms. Thirty-eight cases suspected of having CRS were randomized to have catheter removal and later replacement, or replacement over a guidewire. There were no significant differences in the catheter contamination rate but there were significantly fewer problems of insertion in the guidewire group. However, transfer of Klebsiella sp., during the guidewire procedure, resulted in subsequent sepsis in one case. It is concluded that replacement of catheters over a guidewire is a safe and convenient way of establishing whether sepsis is catheter-related. Because organisms may be transferred, the procedure is not an appropriate treatment for catheter-related sepsis.

Adolescent↗