Search PubMed⌕ Search

Biomedical subjects

T Gottlieb

Publications and source records attributed to T Gottlieb.

At least 19 recordsLinked to original sources
PubMed2002

Laboratory cross-contamination of Mycobacterium tuberculosis: an investigation and analysis of causes and consequences.

BACKGROUND: The misdiagnosis of Mycobacterium tuberculosis infection has many ramifications. These include medical and psychological implications for patients and their families and financial and public health implications for health-care institutions. Microbiology laboratory procedures should minimize the possibility of laboratory cross-contamination of specimens and maximize the ability to recognize a cluster of false-positive cultures. Newer molecular typing methods provide rapid, accurate and effective means of identifying false-positive M. tuberculosis cultures. AIMS: To investigate a cluster of patients with positive M. tuberculosis cultures that were processed in the mycobacteriology laboratory on the same day. METHODS: Five patients' medical records and radiology results were reviewed to determine whether the cases were epidemiologically linked and whether there was clinical suspicion of tuberculosis. Restriction fragment length polymorphism (DNA fingerprinting) was performed using repetitive elements IS6110 and pTBN12. Laboratory processing procedures were analysed. RESULTS: On the basis of DNA fingerprinting using IS6110, the isolates from all five patients were identical. Molecular typing using pTBN12 was performed on four of the five isolates. All four had identical patterns. There was no epidemiological link between the patients. At least three (and probably four) of the five patients were misdiagnosed with tuberculosis. CONCLUSION: Microbiology laboratories should ensure that appropriate methodologies are in place to avoid cross-contamination of specimens. Clinicians need to critically interpret any positive laboratory result, especially in an unlikely clinical setting.

Adult↗
PubMed2001

Multi-drug resistant Pseudomonas aeruginosa outbreak in a burns unit--an infection control study.

A newly introduced, multi-drug resistant (MDR) strain of Pseudomonas aeruginosa was isolated from four patients admitted to the Concord Hospital Burns Unit (BU) between December 1997 and March 1998. It was the cause of recurrent episodes of bacteraemia in two. This strain was resistant in vitro to gentamicin, piperacillin and ciprofloxacin. The isolates were confirmed as a clonal strain by pulse field gel electrophoresis (PFGE). Multiple environmental swabs were taken to search for an environmental reservoir, but no source was identified. Random cultures of staff members' hands failed to demonstrate ongoing carriage. In the absence of a demonstrable point source for the outbreak, direct cross-transmission patient to patient, via transient staff hand contamination, was the most likely route of infection. Following study commencement no new cases of infection with the MDR strain were detected. It would appear that the infection cycle has been interrupted, and the outbreak terminated following the discharge of the last infected patient from the BU. Contamination of a neutral detergent in the BU with Klebsiella oxytoca was detected incidentally during environmental surveillance. A potential hospital-wide outbreak was averted.

Australia↗
PubMed2001

Case report. Successful treatment of cutaneous Paecilomyces lilacinus infection with oral itraconazole in an immune competent host.

A 59-year-old woman presented to us with an eight-month history of Paecilomyces lilacinus soft tissue infection. She was treated with a six-month course of oral itraconazole. The lesion resolved fully without the need for adjunctive surgery. Susceptibility testing confirmed susceptibility to itraconazole. This is the second case of confirmed P. lilacinus soft tissue infection in an immunocompetent host treated with oral itraconazole alone.

Administration, Oral↗
PubMed2000

Multisite regional telephone care.

A multisite, regional telephone-care program staffed by advance practice and critical care nurses has improved patient care and reduced unnecessary clinic and emergency room visits. It allows patients to access the health care system and receive expert advice through the use of the telephone, 24 hours per day, 7 days per week. Computerized patient medical records from eight hospitals and 31 clinics are available to a registered nurse so that informed decisions can be made. The RN records the patient's concern and intervention directly into the patient's medical record, which is transmitted to the primary care provider in real time.

Continuity of Patient Care↗
PubMed1999

Rapid ATM-dependent phosphorylation of MDM2 precedes p53 accumulation in response to DNA damage.

The p53 tumor-suppressor protein, a key regulator of cellular responses to genotoxic stress, is stabilized and activated after DNA damage. This process is associated with posttranslational modifications of p53, some of which are mediated by the ATM protein kinase. However, these modifications alone may not account in full for p53 stabilization. p53's stability and activity are negatively regulated by the oncoprotein MDM2, whose gene is activated by p53. Conceivably, p53 function may be modulated by modifications of MDM2 as well. We show here that after treatment of cells with ionizing radiation or a radiomimetic chemical, but not UV radiation, MDM2 is phosphorylated rapidly in an ATM-dependent manner. This phosphorylation is independent of p53 and the DNA-dependent protein kinase. Furthermore, MDM2 is directly phosphorylated by ATM in vitro. These findings suggest that in response to DNA strand breaks, ATM may promote p53 activity and stability by mediating simultaneous phosphorylation of both partners of the p53-MDM2 autoregulatory feedback loop.

Alkaline Phosphatase↗
PubMed1999

Cat scratch disease diagnosed by polymerase chain reaction in a patient with suspected tuberculous lymphadenitis.

We present a patient diagnosed as having tuberculous lymphadenitis after lymph node biopsy and referred for tuberculous therapy. On review, because of recent cat exposure, she was tested for cat scratch disease (CSD), but serological tests for Bartonella henselae were negative. However, the diagnosis of CSD was confirmed, and tuberculosis excluded, by polymerase chain reaction techniques. This case serves as a reminder that CSD may mimic tuberculosis histologically and that sensitive molecular diagnostic tests are available.

Adult↗
PubMed1999

Fusidic acid in bone and joint infections.

The prominence of staphylococci as the causative agent in bone and joint infections suggests that fusidic acid (FA) has a potentially important role in their treatment. FA has been studied in a broad range of orthopaedic infections, mostly in combination with other antimicrobials. For susceptible organisms, particularly Staphylococcus aureus, it has demonstrable efficacy in acute osteomyelitis, chronic osteomyelitis, specialised forms of osteomyelitis such as calcaneal and vertebral infection, septic arthritis, prosthetic and other device-related infections. A small number of studies have also examined the use of FA alone for the treatment of bone infections, with evidence of good efficacy, as well as the local application of FA in plaster-of-Paris (POP) beads, or incorporated into bone cement, again with promising results. Further studies are required to confirm the efficacy of FA in the treatment of orthopaedic infections caused by methicillin-resistant strains of S. aureus.

Animals↗
PubMed1999

Outcome and complications of temporary haemodialysis catheters.

BACKGROUND: The use of temporary haemodialysis catheters is often complicated by mechanical or infectious complications. Risk factors for these complications and optimal management to reduce their incidence are largely unknown. METHODS: We conducted a prospective study of 105 haemodialysis catheters (79 subclavian, 26 jugular) inserted in 52 patients in order to identify patient outcomes and to analyse the effect of patient and catheter factors on the incidence of infectious complications by multivariate analysis. RESULTS: Fifty-nine per cent of catheters were removed for a suspected complication. Catheter-related bacteraemia (CRB) was diagnosed in 17 catheters (16%), giving a bacteraemia rate of 6.5 episodes per 1000 catheter days. Subgroup analysis revealed a higher risk of CRB with the use of the internal jugular compared with the subclavian site (hazard ratio 3.97, P=0.02). Age, diabetes or catheter exchange over a guidewire did not alter the risk of CRB. The cumulative risk of developing CRB increased in a linear fashion as the period of catheterization increased. Exit-site infection was the cause for removal in eight catheters (8%). Although the number of exit-site infections was small, the risk of exit-site infection was increased in diabetic patients (hazard ratio 10, P=0.03) and the jugular position (hazard ratio 6.5, P=0.01) but not by age or catheter exchange over a guidewire. Staphylococcus aureus and coagulase-negative staphylococcus accounted for all proven episodes of CRB. Exit-site infection was associated with a mixture of Gram-positive and Gram-negative organisms. CONCLUSIONS: Temporary haemodialysis catheters have a high failure rate associated with a significant rate of complications. Use of the internal jugular site is associated with a significantly higher risk of infectious complications and methods to reduce this risk should be considered if this site is used.

Adolescent↗
PubMed1999

Multicenter evaluation of the Abbott LCx Mycobacterium tuberculosis ligase chain reaction assay.

Four Australian hospital laboratories evaluated the performance of the Abbott LCx Mycobacterium tuberculosis assay with 2,347 specimens (2,083 respiratory and 264 nonrespiratory specimens) obtained from 1, 411 patients. A total of 152 specimens (6.5%) were culture positive for Mycobacterium tuberculosis complex (MTBC); of these, 79 (52%) were smear positive. After resolution of discrepant data, the overall sensitivity, specificity, and positive and negative predictive values for the LCx assay were 69.7, 99.9, 99.1, and 97.7% respectively. For smear-positive respiratory specimens that were culture positive for MTBC, the values were 98.5, 100, 100, and 98.4%, respectively, while the values for smear-negative respiratory specimens were 41.5, 99.9, 96.4, and 98%, respectively. Relative operating characteristic curves were constructed to demonstrate the relationship between sensitivity and specificity for a range of possible cutoff values in the LCx assay. These graphs suggested that the assay sensitivity for respiratory samples could be increased from 70.2 to 78.6%, while the specificity would be reduced from 99.9 to 99.4% by inclusion of a grey zone (i.e., LCx assay values of between 0.2 and 0.99). An algorithm is presented for the handling of specimens with LCx assay values within this grey zone.

DNA Ligases↗
PubMed1998

Candidaemia in an Australian teaching hospital: relationship to central line and TPN use.

We performed a retrospective review of patient case records to identify risk factors for candidaemia and to assess incidence, management and outcome of candidaemia in an Australian teaching hospital. Between January 1994 and June 1996, 38 cases of candidaemia were identified. The incidence was 0.74 per 1000 admissions of 24 h duration, and 1.54 per 1000 admissions of 5 days or more. The mortality rate was 34%, with eight of 13 (62%) of these deaths attributable to candidaemia. Risk factors included underlying gastrointestinal disease (66%) and recent abdominal surgery (61%), while recent broad spectrum antibiotic use was a contributing factor in 95%. Twenty-nine patients (76%) had a vascular access device in situ at time of detection. This was the apparent source of candidaemia in 28 (97%). Twenty-six (90%) were being used for TPN administration. Of patients receiving TPN, 5.2% developed candidaemia. Standard central venous catheters (CVC) were present in 21 patients (55%), having been in situ for an average of 12.7 days. Eighteen (86%) had been in situ for 7 days or more. Management involved removal of any implicated intravascular device. Thirty of 33 early survivors received antifungal chemotherapy. Therapy with amphotericin B, fluconazole alone or amphotericin B followed by fluconazole was equally effective. Concurrent corticosteroid use and neutropaenia contributed to increased mortality. Candidaemia is not benign. Policies regarding regular changing of central lines, especially in the setting of TPN administration and control of broad spectrum antibiotic use are appropriate measures aimed to reduce incidence. Management involves removal of implicated lines and antifungal chemotherapy. Pre-emptive therapy for candida infection should be considered in selected patients with the likelihood of TPN-related central line sepsis. Fluconazole is an effective alternative to amphotericin B in non-neutropenic patients.

Adult↗