Search PubMed⌕ Search

Biomedical subjects

V L Yu

Publications and source records attributed to V L Yu.

At least 253 records · Page 14Linked to original sources
PubMed1982

Legionnaires' disease: new clinical perspective from a prospective pneumonia study.

In an attempt to ascertain the incidence of Legionnaires' disease at our hospital, a prospective case-control pneumonia study was conducted for 11 months. Specialized diagnostic tests for Legionella pneumophila, including serologic study, direct immunofluorescent examination, and selective culture, were made routinely available in our hospital. To our surprise, L. pneumophila was the most common cause of pneumonia (22.5 percent) attributable to a single pathogen, followed by Streptococcus pneumoniae (10.6 percent). In 68.8 percent of the cases, Legionnaires' pneumonia was hospital-acquired. In contrast to other investigators, we found that abdominal pain, diarrhea, neurologic signs, abnormal liver function results, hypophosphatemia, and hematuria did not occur significantly more frequently in pneumonia caused by L. pneumophila than in that caused by other microorganisms. However, hyponatremia within five days of onset of pneumonia occurred significantly more frequently in Legionnaires' disease (p less than 0.0001). Since the clinical presentation is nonspecific, specialized laboratory tests are necessary to make the diagnosis. As a result of our experience, we suggest an approach using serologic tests as a screen to determine whether more specialized tests for Legionnaires' disease should be introduced into a hospital without previously recognized cases of Legionnaires' disease.

Diagnosis, Differential↗
PubMed1981

Steady-state moxalactam kinetics: comparisons with other cephalosporins.

Moxalactam is a new beta-lactam antimicrobial with an extended spectrum. Serum concentrations were determined in 14 patients at steady state using bioassay and high-pressure liquid chromatography methods. Mean peak and trough serum concentrations were 195 and 29.5 micrograms/ml for the 20-gm dose and 214 and 28.8 micrograms/ml for the 3-gm dose. Peak and trough levels exceeded the minimum inhibitory concentration of the infecting bacteria in 100% and 67% of the patients. The 3-gm dose is recommended for infections caused by Pseudomonas aeruginosa and other organisms with higher minimum inhibitory concentrations. Half-lifes ranged from 1.7 to 5.7 hr and reflected the varying renal functions of the patients. A relationship (r = 0.878, p less than 0.001) between creatinine clearance and elimination rate constant was established by bivariant linear regression analysis.

Adult↗
PubMed1981

Measurement of serum and tissue concentration of moxalactam using high pressure liquid chromatography.

We describe a sensitive high pressure liquid chromatographic (HPLC) procedure for the analysis of the new beta-lactam antibiotic moxalactam. Conditions are described for either measurement of total drug concentration or the concentration of the individual isomers. The proteins in a 1.0 ml plasma sample are denatured with isopropyl alcohol which is then extracted into a chloroform reagent, leaving the drug in the aqueous phase. An aliquot is then injected into a mu-bondapak phenyl column. A similar extraction procedure was employed for tissue homogenates. Linear regression analysis and comparison of the HPLC assay with the microbiological assay gave a correlation coefficient of 0.97. Analysis of tissue samples indicated that significant concentrations of moxalactam were obtained at the site of infection.

Biological Assay↗
PubMed1981

Isolation of Legionella pneumophila from hospital shower heads.

Legionella pneumophila serogroup 6 was isolated from nine of 16 shower heads in a Chicago hospital ward where three patients had contracted Legionnaires' disease caused by serogroup 6 L. pneumophila. Each patient had showered there 2 to 10 days before the onset of disease symptoms. We also isolated the bacteria in two other hospitals, and found the same serogroups as had been causing Legionnaires' disease in those hospitals: serogroup 1 in Pittsburgh and serogroups 1 and 4 in Los Angeles. However, showers from hospital wards where no patients had contracted Legionnaires' disease also yielded L. pneumophila. Shower heads at the Chicago hospital were sterilized with ethylene oxide but rapidly became recontaminated, suggesting that the potable water at these hospitals may have contained the organism. The question of whether aerosols of shower water or other exposures to potable water containing L. pneumophila may cause nosocomial Legionnaires' disease has not been resolved but deserves further study.

Baths↗
PubMed1980

Synergistic interaction in vitro with use of three antibiotics simultaneously against Pseudomonas maltophilia.

An abbreviated three-dimensional checkerboard titration method was devised to determine whether synergistic interaction of three antimicrobial agents could be found against multidrug-resistant bacteria. Pseudomonas maltophilia was used as the test organism because of its resistance to most commercially available antimicrobial agents, including those active against Pseudomonas aeruginosa. Three-dimensional isobolograms with concave surfaces were formed when synergy occurred. Triple combinations of gentamicin-carbenicillin-rifampin (mean fractional inhibitory concentration index, 0.32) and trimethoprim/sulfamethoxazole-carbenicillin-rifampin (mean fractional inhibitory concentration index, 0.18) were consistently synergistic against 14 clinical isolates of P. maltophilia.

Carbenicillin↗
PubMed1980

Comparative susceptibilities of Pseudomonas aeruginosa to 1-oxacephalosporin (LY 127935) and eight other antipseudomonal antimicrobial agents (old and new).

In vitro susceptibilities of 53 clinical isolates of Pseudomonas aeruginosa to nine antipseudomonal antibiotics were determined. From 96 to 100% of the isolates were susceptible to piperacillin, ticarcillin, and 1-oxacephalosporin (LY 127935). Of the aminoglycosides, 89, 82, 79, and 29% were susceptible to amikacin, tobramycin, gentamicin, and netilmicin, respectively. A total of 96% and 78% of the isolates were susceptible to 1-oxacephalosporin (LY127935) and cefotaxime, respectively, at concentrations of 62.5 micrograms/l. Supplementation of testing media by calcium and magnesium not only markedly increased the minimal inhibitory concentrations of the aminoglycosides, but also raised those of cefotaxime and the penicillins; no significant effect was noted with 1-oxace-phalosporin. Synergy was not demonstrated consistently in vitro with 1-oxace-phalosporin combined with either carbenicillin, ticarcillin, gentamicin, or tobramycin.

Anti-Bacterial Agents↗
PubMed1979

Antimicrobial selection by a computer. A blinded evaluation by infectious diseases experts.

An evaluation of a computer-based consultation system called MYCIN was made. Eight independent evaluators with special expertise in the management of meningitis compared MYCIN's choice of antimicrobials with the choices of nine human prescribers for ten test cases of meningitis. MYCIN received an acceptability rating of 65% by the evaluators; the corresponding ratings for acceptability of the regimen prescribed by the five faculty specialists ranged from 42.5% to 62.5%. The system never failed to cover a treatable pathogen while demonstrating efficiency in minimizing the number of antimicrobials prescribed. The study design may be useful in assessing the performance of other computer-based clinical decision-making systems.

Adult↗
PubMed1979

Patient factors contributing to the emergence of gentamicin-resistant Serratia marcescens.

One hundred forty nosocomial Serratia marcescens infections (including 76 cases of bacteremia) were identified by prospective surveillance from 1975 through 1977 and retrospective chart review from 1968 through 1974. Thirty-four cases (24 per cent) involved gentamicin-resistant strains. All gentamicin-resistant strains appeared after 1974. Ninety per cent of the patients had undergone surgery, and 88 per cent had received prior antimicrobial therapy. The emergence of gentamicin-resistant S. marcescens paralleled the increase in usage of gentamicin. Prior use of gentamicin for more than two days in an individual patient was a significant risk factor (P = 0.0002) for being infected with a Serratia that was gentamicin-resistant. Other factors which separated gentamicin-resistant Serratia infections from gentamicin-sensitive Serratia infections were (1) urinary site of infection (P = 0.0005), (2) urinary catheter (P = 0.002), (3) endotracheal tube or tracheotomy (P = 0.03) and (4) increasing duration of hospitalization (P less than 0.05). Thirty-three of 34 (97 per cent) patients with gentamicin-resistant strains had urinary catheters. Specific measures to control infection were effective in decreasing the incidence of infections caused by gentamicin-resistant Serratia.

Adolescent↗
PubMed1979

Evaluating the performance of a computer-based consultant.

The performance of a computer-based clinical consultation system is evaluated. The program, called MYCIN, is designed to function as an aid for infectious disease diagnosis and therapy selection, with an initial emphasis on bacteremias. The evaluation methodology is discussed, as well as the difficulties encountered in attempting to evaluate clinical judgments. Specialists in infectious diseases judged MYCIN's final therapy recommedation, and intermediate conclusions about the significance of the infection and identity of infecting organisms. The evaluation techniques described may be useful in assessing the performance of other clinical decision aids. Results of the evaluation show that the program's therapy recommedations meet Stanford experts' standards of acceptable practice 90.9% of the time (table 2), with some variation noted both among individual experts and between Stanford experts and others (tables 1, 2).

Animals↗
PubMed1979

Susceptibility of Pseudomonas maltophilia to antimicrobial agents, singly and in combination.

Pseudomonas maltophilia is resistant to most of the commonly used antimicrobial agents including those active against Pseudomonas aeruginosa. The susceptibility of 14 clinical isolates of P. Maltophilia to 18 antimicrobial agents was determined by broth dilution testing. All organisms were susceptible to trimethoprim-sulfamethoxazole (TMP-SMZ), minocycline, and LY127935. A total of 87 and 79% of the organisms were susceptible in vitro to colistin and chloramphenicol, respectively. With the exception of sisomicin, the organisms were resistant to the aminoglycosides. Of 21 combinations of antimicrobials examined for synergy, only the combination of TMP-SMZ with carbenicillin was consistently (86%) synergistic in vitro. Supplementation of the testing media with calcium and magnesium increased the minimal inhibitory concentrations for the aminoglycosides, the penicillins, and TMP-SMZ against P. maltophilia.

Aminoglycosides↗
PubMed1978

Pseudomonas maltophilia causing heroin-associated infective endocarditis.

The association of Pseudomonas maltophilia endocarditis in three patients with recent history of intravenous drug abuse is reported. All three patients had abnormal heart valves (two prosthetic and one rheumatic). A prominent characteristic of this uncommon pathogen is its in vitro resistance to the commonly used antimicrobials. Cure was achieved in all three cases. In two cases, synergistic antibiotic combinations were used. In one case, plasmid-mediated resistance to amikacin sulfate (Amikan, British; no comparable US product) emerged during therapy. The two patients with prosthetic valves received combined surgical and antibiotic therapy.

Adult↗
PubMed1977

Amikacin therapy. Use against infections caused by gentamicin- and tobramycin-resistant organisms.

Amikacin sulfate was used in 24 treatment courses for 25 serious infections caused by aerobic or facultative anaerobic Gram-negative organisms resistant to numerous drugs. Sites of infection included urinary tract (11 cases), pleuropulmonary (6 cases), primary bacteremia (5 cases), and miscellaneous (3 cases). Serratia marcescens and Pseudomonas sp accounted for 73% of the isolates. The mean minimal inhibitory concentration (MIC) of these organisms to amikacin was 3.6 microgram/ml; to gentamicin, 39 microgram/ml; and to tobramycin, 32 microgram/ml. The mean peak serum concentration of the drug was 20.8 microgram/ml. Eleven patients were critically ill at the onset of therapy, and seven patients were bacteremic. The overall favorable response rate was 80%. The most serious side effect was ototoxicity, which occurred in three of 15 patients examined by serial audiometry.

Adult↗