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T Worthington

Publications and source records attributed to T Worthington.

18 recordsLinked to original sources
PubMed2002

Avoiding the point.

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Allied Health Personnel↗
PubMed2002

A rapid ELISA for the diagnosis of intravascular catheter related sepsis caused by coagulase negative staphylococci.

AIM: To develop and evaluate a rapid enzyme linked immunosorbent assay (ELISA) for the diagnosis of intravascular catheter related sepsis caused by coagulase negative staphylococci. METHODS: Forty patients with a clinical and microbiological diagnosis of intravascular catheter related sepsis and positive blood cultures, caused by coagulase negative staphylococci, and 40 control patients requiring a central venous catheter as part of their clinical management were recruited into the study. Serum IgG responses to a previously undetected exocellular antigen produced by coagulase negative staphylococci, termed lipid S, were determined in the patient groups by a rapid ELISA. RESULTS: There was a significant difference (p = < 0.0001) in serum IgG to lipid S between patients with catheter related sepsis and controls. The mean antibody titre in patients with sepsis caused by coagulase negative staphylococci was 10 429 (range, no detectable serum IgG antibody to 99 939), whereas serum IgG was not detected in the control group of patients. CONCLUSIONS: The rapid ELISA offers a simple, economical, and rapid diagnostic test for suspected intravascular catheter related sepsis caused by coagulase negative staphylococci, which can be difficult to diagnose clinically. This may facilitate treatment with appropriate antimicrobials and may help prevent the unnecessary removal of intravascular catheters.

Adolescent↗
PubMed2000

Is hospital-acquired intravascular catheter-related sepsis associated with outbreak strains of coagulase-negative staphylococci?

Macrorestriction fragment profile analysis by pulsed field gel electrophoresis was used to type strains of coagulase-negative staphylococci (CNS) isolated from 30 patients with catheter-related sepsis at the University Hospital Birmingham NHS Trust, UK. Twenty-three infections were hospital-acquired. A total of 56 CNS were isolated from the patients and identified by API as Staphylococcus epidermidis (54), Staphylococcus lugdunensis (1) and Staphylococcus hominis (1). The micro-organisms were further characterized by antibiograms and restriction digestion using SmaI. Analysis of the macrorestriction fragment profiles demonstrated that the isolates from 24 patients were distinct, whereas a common genotype of S. epidermidis was isolated from the blood cultures of six patients, all of whom had acquired this infection in hospital. Three of these patients were located in a haematology ward, two on an intensive care unit and one on a dialysis unit. The data from this current study suggests that specific strains of S. epidermidis may be an important cause of nosocomial catheter-related sepsis resulting from cross-infection, and that this association would not be detected by conventional typing methods including biotyping and antibiograms.

Catheterization, Central Venous↗
PubMed2000

A novel serological test for the diagnosis of central venous catheter-associated sepsis.

OBJECTIVES: To determine the sensitivity and specificity of a novel antibody test for the diagnosis of intravascular catheter-related infections due to coagulase-negative staphylococci. METHODS: Sixty-seven patients diagnosed as having central venous catheter (CVC)-associated sepsis based on strict clinical criteria, including positive blood cultures, were compared to 67 patients with a CVC in situ who exhibited no evidence of sepsis. An ELISA serological test based on a novel short-chain lipoteichoic acid antigen isolated from coagulase-negative staphylococci (CNS) was used to determine the patient's serological response (IgG and IgM) to CVC sepsis caused by CNS. The specificity and sensitivity of the test was determined. RESULTS: There was a significant increase in the antibody levels (IgG and IgM) to the short-chain lipoteichoic acid in patients with CVC-associated staphylococcal sepsis as compared to the control patients. CONCLUSIONS: This new serological method may offer a useful diagnostic test for intravascular catheter infections caused by staphylococci.

Adolescent↗
PubMed2000

Lipid S, a novel Staphylococcus epidermidis exocellular antigen with potential for the serodiagnosis of infections.

We describe the characterisation of a novel glycerophosphoglycolipid (termed lipid S) produced by Staphylococcus epidermidis grown in a chemically defined medium. Lipid S is a short chain length form of the cellular lipoteichoic acid (LTA). It shares common antigenic determinants with LTA, but its chain length of six glycerophosphate units contrasts with 40-42 units in LTA. Lipid S is exocellular and can be recovered from liquid growth medium whereas LTA is associated with the cell wall and membrane. Healthy individuals have low serum levels of IgG against lipid S, but significantly higher titres have been detected in serum from patients with central venous catheter-related sepsis due to coagulase-negative staphylococci and infection of orthopaedic prostheses. An indirect enzyme-linked immunosorbent assay test based on lipid S allows the rapid diagnosis of Gram-positive infection and may have clinical applications in the management of patients with sepsis.

Antigens, Bacterial↗
PubMed2000

A continuing role for surgical bypass in the palliative treatment of pancreatic carcinoma.

BACKGROUND: The use of palliative surgery for irresectable pancreatic cancer has been challenged by the advent of non-operative stenting, but it may still be appropriate for selected patients. METHODS: Single-loop biliary and gastric bypass was carried out in 56 patients (mean age 60 years) with carcinomas of the pancreatic head that were irresectable because of vascular invasion or distant spread. In 42 patients without a preoperative tissue diagnosis, ductal carcinoma was confirmed by biopsy of the primary (n = 20) or secondary (n = 22) tumour. Preoperative biliary decompression in 31 patients led to positive bile cultures in 22 of 24 patients sampled. RESULTS: There were no deaths in hospital or within 30 days. Complications in 20 patients (35%) included three biliary leaks, two of which required temporary percutaneous stents. The median postoperative hospital stay was 14 days. No re-operations were required before death, though 2 patients required percutaneous stenting of the biliary anastomosis for recurrent jaundice, 1 of whom had a radiation-induced stricture. The median survival was 6 (range 2-21) months. CONCLUSION: Combined biliary and gastric bypass can be carried out with reasonable safety and remains a useful option for patients with potentially resectable tumours and an anticipated life expectancy of at least 6 months.

Adenocarcinoma↗
PubMed2000

Serological detection of Gram-positive bacterial infection around prostheses.

Coagulase-negative staphylococci produce an exocellular glycolipid antigen which has potential as a serological marker of infection in bone. The value of this newly detected antigen was investigated by enzyme-linked immunosorbent assay (ELISA) in 15 patients with culture-proven infection of prostheses caused by Gram-positive bacteria. The antigen was purified by gel-permeation chromatography from the culture supernatants of coagulase-negative staphylococci grown in a chemically defined medium. There were significant differences (p < 0.0001) between the serum IgG and IgM levels in patients with infection due to Gram-positive staphylococci and those of a control group of 32 patients with no infection. The ELISA test, which has potential for the diagnosis of infection, may be valuable in distinguishing between staphylococcal infection around prostheses and aseptic loosening.

Adult↗
PubMed1998

Ad HoC conferences of hospital and community professionals in cases of hospitalized physically abused children.

OBJECTIVE: Although community interagency child protection teams are common and well described in the literature, they may not meet the needs of investigating agencies when children are hospitalized in tertiary medical facilities some distance from their homes. Sometimes, the communities in which they live do not have effective teams, or the information to be conveyed is highly technical. This report describes and assesses ad hoc multi-agency conferences with varying hospital and community agency participants, each conference devoted to a single hospitalized child suspected of having been abused. METHOD: A questionnaire devised by the authors was administered by telephone to 22 former conference participants from state social agencies, law enforcement units, and prosecuting attorney's offices. RESULTS: Most of the surveyed participants reported the case-specific conferences to have been helpful, meeting their goals and affecting the outcomes of their cases. CONCLUSION: The conferences appear to have been worthwhile. Although they were associated with some disadvantages for the involved professionals and the sponsoring hospital, the disadvantages appeared to have been offset by the potential benefits for the children, families, participants, and hospital.

Child↗