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T T Ward

Publications and source records attributed to T T Ward.

23 records · Page 2Linked to original sources
PubMed1978

Acidosis of synovial fluid correlates with synovial fluid leukocytosis.

The antibacterial activity of aminoglycoside antibiotics is significantly reduced by lowering the pH of the incubation medium. Since gram-negative septic arthritis responds poorly to aminoglycoside antibiotic therapy, we sought to determine whether synovial fluid acidosis contributes to this poor outcome. Synovial fluid samples from 22 patients with various forms of acute and chronic arthritis were examined for white blood cell count and pH. A close correlation (r = -0.92, p is less than 0.001) between an increasing white blood cell count and a decreasing pH was demonstrated. Since septic arthritis is associated with high white blood cell counts, in synovial fluid, the resultant low pH may contribute to the poor response to gram-negative septic arthritis treated with aminoglycoside antibiotics.

Adult↗
PubMedDate not supplied

Detection of aminoglycoside ototoxicity by high-frequency auditory evaluation: selected case studies.

A practical monitoring procedure utilizing frequencies higher than those tested by conventional audiometry for the detection of ototoxicity has the potential for preventing or minimizing irreversible communication deficits in patients receiving aminoglycoside antibiotic therapy. If ototoxicity produced by these drugs could be detected before it progresses to involve the frequencies essential for communication, it might be possible to lower the dose or to change to another antibiotic to prevent a permanently handicapping hearing impairment. From a total of 77 patients monitored by serial audiograms, three case studies illustrate the various types of auditory sensitivity changes observed with high-frequency audiometry. Ototoxicity was generally detected by high-frequency auditory testing before it could be detected by conventional audiometric procedures. These cases demonstrate the utility of monitoring audition at frequencies higher than those tested conventionally in patients receiving aminoglycoside antibiotics.

Adult↗
PubMedDate not supplied

Nosocomial urinary tract infection: a prospective evaluation of 108 catheterized patients.

This study describes the evaluation of 108 patients who had indwelling urethral catheters for acute medical and surgical indications. Patients were evaluated daily, and cultures from bladders and drainage bags were obtained. Appropriateness for continuing catheterization was assessed using preset criteria. Twenty-five patients developed urinary tract infections. Exposure to antibiotics and a shorter duration of catheterization were the only factors that correlated significantly with a delayed onset or decreased prevalence of infection. Factors found to have insignificant effects included age, sex, maintenance of the closed system, underlying host disease status, catheter type, and reason for catheterization. No collection systems with one way valves were used, but significantly colony counts in drainage bag urine preceded urinary tract infection in only two patients. Thirty-six percent of the total 562 catheter days were judged unnecessary. A major emphasis must be placed on prompt catheter removal if the prevalence of nosocomial urinary tract infections is to be reduced substantially in a cost-effective manner.

Anti-Bacterial Agents↗
PubMedDate not supplied

Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: role of antimicrobial therapy in infection control.

Clinical, bacteriologic, epidemiologic and hospital infection-control observations related to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus are described. The outbreak involved 66 patients at the University of Oregon Health Sciences Center (UOHSC) and its closely affiliated VA hospital, the Portland VA Medical Center (PVAMC). No environmental source of infection was identified; person-to-person transmission was most likely responsible for its spread. Surveillance cultures demonstrated nasal colonization in house staff and nursing personnel at both hospitals. Inter-hospital transfer of infection was, in all likelihood, achieved via nasal carriage by a single physician. Case-control analysis indicated a significantly increased risk (p less than 0.05) of acquisition of infection related to age, number of days hospitalized, severity of underlying disease and number of invasive procedures. Prior antibiotic receipt was a significant risk factor when analyzed by univariate analysis (p less than 0.01), but, in contrast to previous studies, this was not a significant risk factor (p greater than 0.05) when related variables were controlled by multivariate analysis. Prevention of spread of infection by routine infection control measures was less effective at PVAMC than at UOHSC. Patients at PVAMC were significantly older and had longer durations of hospitalization (p less than 0.05). Antimicrobial therapy of colonized patients and personnel appeared to assist in the control of the outbreak at PVAMC. Antimicrobial therapy with topical bacitracin and oral rifampin, alone or in combination with oral trimethoprim-sulfamethoxazole, was effective in eliminating colonization with methicillin-resistant S. aureus.

Administration, Oral↗