Prospective multihospital surveillance studies--a controversy.
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Cross Infection↗
Biomedical subjects
T Sacks
Publications and source records attributed to T Sacks.
Epidemiological observations in the AIDS clinic at the Hadassah University Hospital in Jerusalem.
Of the first 395 attendees at the AIDS clinic in Jerusalem, 32% were homo/bisexuals, 4% i.v. drug abusers (IVDAs), 24% persons with minimal risk for AIDS and 38% were persons having no risk. Human immunodeficiency virus (HIV) antibody rates were 7% for homosexuals, 29% for IVDAs, 1% for persons with minimal risk and 0% for persons at no risk. Israeli homosexuals had a significantly greater risk for HIV infection (9 of 35) if they had sexual contact with non-Israelis as compared with homosexuals who had contact with local partners only (0/91, P less than 0.001). The mean number of attendees per month increased by 431% during the 4 months following the first prime-time television program on AIDS. The largest mean increases occurred among persons at no risk (1 to 27.2), those with minimal risk (2.5 to 16.5), and among women (1.25 to 20.0). This report indicates that HIV infection among Israeli homosexuals has not yet reached U.S. proportions. It also shows that the TV program raised anxiety concerning AIDS among the general public, and probably encouraged the public to use HIV testing as part of a general health screening program.
Acquired Immunodeficiency Syndrome↗
Prophylactic antibiotics in traumatic wounds.
There is well-documented evidence justifying, perhaps demanding, the obligatory use of early, anticipatory treatment in open fractures and in penetrating abdominal wounds, and equally convincing evidence that they are not indicated in fractures of the base of the skull with CSF leaks, in thermal injuries, or in simple lacerations. As far as penetrating chest wounds, and bites are concerned, the evidence is perhaps as yet inconclusive, but antibiotics are probably not indicated in these situations.
Animals↗
The Israeli Study of Surgical Infections (ISSI): I. Methods for developing a standardized surveillance system for a multicenter study of surgical infections.
The postoperative wound infection experience in 11 Israeli hospitals was investigated with two objectives: (1) to utilize the variability among hospitals for a better understanding of the determinants of these infections, and (2) to present surgeons and infection control teams with information upon which they can take action. This article summarizes the methods that were applied to maximize the uniformity of information obtained from hospitals. (1) The same kind of patients were sampled in every hospital. (2) The data collection system was standardized, and analyzed for errors. The overall error rate was small (2%) but there were potential problem areas, such as missing information on underlying diagnoses (12%). Few errors (1%) were found in the nurses' observations of the wounds. (3) All wound infections were diagnosed in a uniform manner by convening a panel of four specialists at the central Israeli Study of Surgical Infections (ISSI) office. (4) The definition of infection that was finally chosen for this multicenter study had to be broadened to include, in addition to pus, "discharge other than pus," because of the higher reliability among panel members. This definition was also clinically valid in terms of morbidity. (5) The rate of postdischarge infections was estimated and was not found to be related to the discharge policies in the various hospitals.
Data Collection↗
Treatment of intraventricular cryptococcal granuloma: correction.
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Brain Diseases↗
Synergism between gentamicin and mitomycin C in staphylococcal infections in mice.
Mitomycin C, an antineoplastic antibiotic, and gentamicin showed a dose-related protective effect in mice against a lethal staphylococcal infection when used singly. A combination of these two drugs was shown to be synergistic in the mouse model. A specific logistic regression analysis method confirmed that a synergistic bactericidal effect was obtained with the combination.
Animals↗
Recurrent urinary tract infections in premenopausal women: prophylaxis based on an understanding of the pathogenesis.
We studied 56 sexually active premenopausal women with a normal genitourinary tract but with persistent introital colonization by enteric gram-negative bacteria who were prone to suffer recurrent urinary tract infections. Sexual intercourse was revealed as a major factor in inducing recurrent urinary tract infections, usually within 24 hours, by transferring the pre-existing introital bacteria into the bladder. Abstention from sexual activity without any additional treatment prevented the development of new urinary tract infections in these women despite persistent introital enteric bacterial flora. Urinary tract infections occurred after onset of sexual activity in all but 2 of the premenopausal women in this study. The 25 premenopausal women with recurrent urinary tract infections were subjected to early postcoital prophylaxis consisting of bladder voiding and the administration of a single tablet of either cotrimoxazole (80 mg. trimethoprim plus 400 mg. sulfamethoxazole), nalidixic acid (500 mg.), nitrofurantoin (50 or 100 mg.) or sulfonamides (500 mg. sulfisoxazole or 250 mg. sulfamethizole). Whereas 70 urinary tract infections occurred during a mean 8-month followup before treatment only 4 occurred during the mean 12.5-month followup after introduction of post-coital prophylaxis (none occurred on co-trimoxazole or nalidixic acid therapy and only 1 infection occurred on nitrofurantoin therapy). Sulfonamides are not recommended as post-coital prophylaxis because of the higher incidence of breakthrough infections. Post-coital prophylaxis with co-trimoxazole, nalidixic acid or nitrofurantoin proved to be simple, economical and efficient, and is recommended in the prevention of recurrent urinary tract infections in otherwise normal premenopausal women.
Adult↗
Treatment of febrile granuloycytopenic cancer patients receiving antineoplastic therapy with a combination of carbenicillin, cefazolin and gentamicin.
A three drug regimen of carbenicillin, cefazolin and gentamicin was used for the treatment of patients with solid tumors, who developed fever while granulocytopenic following chemotherapy. Thirty-five (8%) of 426 cancer patients receiving various combinations of antineoplastic chemotherapy qualified for the antibiotic treatment. Nine patients (26%) had bacteriologically confirmed infections, all with gram negative microorganisms. Twenty-four patients (69%) recovered and eleven (31%) died. All deaths occurred within five days of antibiotic therapy; in patients who recovered, the fever subsided within six days. Mortality was not influenced by the presence of a positive bacterial culture, age, or the cytotoxic agents used. It was, however, strongly related to metastatic spread: nine out of 14 patients with liver metastases (64%) died from the infection, while only two of 11 patients (18%) with other metastatic sites failed to respond to the antibacterial therapy. No death occurred in 10 patients who had local disease or received adjuvant therapy. This combined antibiotic therapy was as effective as reported for other combinations, with no serious side effects.
Adolescent↗
[Recommendations of the Hadassah University Hospital Committee for active immunization against hepatitis B virus infection].
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Hepatitis↗
Infective endocarditis in Jerusalem. A comparative analysis of native and prosthetic valve endocarditis.
Thirty patients with prosthetic valve endocarditis (PVE) and 62 patients with native valve endocarditis (NVE) observed during a concurrent period of time (1970-80) were analyzed. Patients with PVE were also compared with 697 patients who underwent cardiac valve replacement in the same period, in an attempt to uncover risk factors for PVE. In the operated patients the overall incidence of endocarditis was 4.3%. There were several significant differences between the NVE and PVE groups. Atrial fibrillation was more prevalent in the PVE group (33.4 vs. 11.5%, P less than 0.05), while infection with gram-positive organisms was more prevalent in the NVE patients (79 vs. 47%, P less than 0.01). The outcome of combined medical and surgical treatment showed a much higher mortality rate (50 vs. 6.4%, P less than 0.01) in the PVE group. Staphylococcal endocarditis resulted in 16% mortality in NVE vs. 100% in the PVE group (P less than 0.01). Careful surveillance may hopefully lead to early detection, treatment and better outcome of PVE.
Adolescent↗
Hypothesis: new concepts on the pathogenesis of early prosthetic valve endocarditis.
During the years 1970-1980, 697 patients had valve replacement surgery at our institution. Thirty patients subsequently developed prosthetic valve endocarditis (P.V.E.). Reexamination of the native valves of 25 of these patients revealed histopathological evidence of thromboendocarditis in 7, 5 of whom subsequently developed early P.V.E. In 3 out of 25 matched controls in whom P.V.E. was not diagnosed clinically, similar pathological findings were found; these patients all had fever pre- or post-operatively and were treated with a short antibacterial course, but no definite clinical diagnosis was made. We suggest that there is a close relationship between subclinical thromboendocarditis on the native valve and the early development of infective endocarditis on the implanted artificial valve.
Endocarditis, Bacterial↗
A decisive period in cefoxitin prophylaxis of experimental synergistic wound infection produced by Bacteroides fragilis and Escherichia coli.
In an experimental model of synergistic infection produced by Escherichia coli and Bacteroides fragilis, a single injection of cefoxitin 1 h before inoculation of the bacteria was able to prevent both death and local wound infection (P less than 0.05). When cefoxitin was administered 1 h after the bacterial inoculum, death of the animals, but not the wound infection, was prevented (P greater than 0.1). Cefazolin, active against the E. coli only, could prevent death, but had no significant effect (P greater than 0.1) on the prevention of wound sepsis.
Animals↗
Deleterious effects of endotoxin on cultured endothelial cells: an in vitro model of vascular injury.
The effects of endotoxin-triggered granulocytes on the viability of endothelial cells in vitro was investigated. Endotoxin or its lipid A component caused granulocytes to adhere to and significantly damage cultured endothelial cells. Fresh serum is not necessary but does amplify both adherence and endothelial injury. Much of the endothelial injury was inhibited by free-radical scavengers or by blocking granulocyte adhesion to endothelial cells and appears to result from free radical production by the stimulated granulocyte. Studies in this model suggest a pathogenic role for the endotoxin-triggered granulocyte in the Shwartzman reaction and perhaps related clinical disorders.
Bacterial Toxins↗
The bacterial flora of the vaginal vestibule, urethra and vagina in premenopausal women with recurrent urinary tract infections.
Gram-negative enteric bacteria, mainly Escherichia coli, form the predominant microbial flora of the introitus, vagina and urethra in women with a normal genitourinary tract but who are prone to suffer recurrent urinary infections. The infections in these women tend to occur in greater numbers and persist for long intervals, compared to normal control women who never experience urinary infections and in whom the main introital, vaginal and urethral microbial flora consists of lactobacilli and staphylococci. The appearance of gram-negative enterobacteria in the normal and control subjects usually is a rare and transitory event. The majority of urinary tract infections that developed in our population during this study was preceded by a persistent similar gram-negative vulvovaginal and urethral microbial flora. However, prolonged spontaneous intervals occurred occasionally during which the introital, vaginal and urethral cultures were free of gram-negative bacteria, with simultaneous intervals free of infection. Nevertheless, all of these intervals ended with documented urinary tract infections. The introital culture is a reliable mirror of the vulvovaginal and urethral microbial flora and, therefore, it is adequate in the study of urinary infections in women.
Enterobacteriaceae↗
A decisive period in the antibiotic prophylaxis of cutaneous lesions caused by Bacteroides fragilis in guinea pigs.
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Animals↗
Effect of an R plasmid on the virulence of a hospital strain of Escherichia coli.
The virulence of a multiple antibiotic-resistant isolate of Escherichia coli was compared to that of the same isolate 'cured' of its resistance by acridine orange, and to that of the cured bacteria transformed back to resistance by the plasmid DNA extracted from the original resistant isolate. There were virtually no differences in the mouse LD 50 of these three variants of the same organism.
Animals↗
Comparative studies on the antimicrobial activity of peritoneal and ascitic fluids in human beings.
The antibacterial activity of peritoneal fluid obtained from 28 women undergoing laparoscopy was compared with that of ascitic fluid obtained from 11 patients with various pathologic conditions. Similar antibacterial activity was found in these two types of fluid. The activity varied from bactericidal to bacteriostatic and was directed mainly against gram-negative bacilli-Escherichia coli, Proteus mirabilis and Bacteroides fragilis. Candida albicans was inhibited by many of the fluids, but the activity against gram-positive cocci was much less marked. Lysozyme was present in the fluids but was not solely responsible for the antimicrobial activity. The results of this study suggest the presence of at least three groups of thermostable antibacterial substances, two of which are bactericidal and one, bacteriostatic. One of the bactericidal factors is complement-dependent.
Ascitic Fluid↗