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Biomedical subjects

W Fegeler

Publications and source records attributed to W Fegeler.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Pneumonia in immunocompromised patients: the value of non-biopsy bronchoscopic examination procedures in the diagnosis of pathogens].

Bronchoscopy was performed on 101 immunocompromised patients with fever and pulmonary infiltrates. Underlying diseases were mainly hematological malignancies. In 71% of cases, etiology of pneumonia was clarified by nonbioptic bronchoscopic methods (bronchoalveolar lavage, bronchial secretions, protected specimen brush). In 51% of cases, empirical antibiotic treatment was modified following bronchoscopy. In patients with early bronchoscopy a better prognosis regarding healing and survival was observed than in those cases, where bronchoscopy was performed later during pneumonia. Bronchoalveolar lavage was particularly suited for diagnosis of Pneumocystis carinii and pneumonia due to viruses or Legionella. Sensitivity and specificity of bronchoscopy were lower for diagnosis of mycotic pneumonia and of Gram-negative or Gram-positive bacteria.

Aspergillosis↗
PubMed1990

Infection surveillance and selective decontamination of the digestive tract (SDD) in critically ill patients--results of a controlled study.

All ICU patients were continuously monitored for infections according to a standard protocol by the physician in charge and an infection control nurse during the first quarter of five consecutive years (1980-1984). The number of patients surveyed was 1,009. The average age was 45.5 years and the average period of stay about four days. 733 patients (72.6%) were intubated and artificially ventilated for three days. A fatal outcome resulted in 13.2% of all patients, 1,129 nosocomial infections were registered in 331 patients, which means an infection rate of 32.8%. The most frequent nosocomial infections were those of the respiratory tract (24.3%). Wound infections developed in 16.6%. The urinary tract was affected in 8.8%. Nosocomial septicaemias were observed in 8.7%. Catheter-associated infections were found in 6.7% of the patients. A fatal outcome resulted in 26% of the patients with nosocomial infections and in 6.9% of the non-infected patients, respectively. There was no significant reduction in nosocomial infections over the five-year period in our ICU. Therefore, a study was designed to evaluate the concept of selective decontamination of the digestive tract (SDD) in critically ill patients in our two surgical/traumatological ICUs. A prospective, consecutive, placebo-controlled study in two ICUs was carried out during four six-month periods. 200 patients who were intubated for at least three days, required intensive care for a minimum of five days, and belonged to either class III or IV according to the "Therapeutic Intervention Scoring System" were included in the study. They received either placebo or a prophylaxis regimen, consisting of polymyxin E, tobramycin and amphotericin B.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Methodological aspects of a microidentification technique for the differentiation of coagulase-negative staphylococci to species level.

The increasing number of coagulase-negative staphylococci (CNS) obtained from clinical material requires a biochemical identification on a broad basis in order to get a better determination of the clinical relevance of the single species. The method of differentiation presented is based on an inoculated microtiter plate provided with reagents and indicators which is evaluated by means of a coding system including most variations of the typical enzyme patterns. As a result of 7040 test series with 55 defined strains, a high degree of plausibility and reproducibility of the single reactions was found in 1320 tests under the recommended conditions. The biochemical patterns of 1380 strains taken from the diagnostic routine were established by means of this method. Comparisons with a commercially available system showed a large congruence of the single reactions and the results of identification.

Bacterial Typing Techniques↗
PubMed1990

Hepatosplenic candidosis--a late manifestation of Candida septicemia.

Hepatolienal candidosis was diagnosed in 27 patients suffering from malignant hematologic disorders. All patients had received intensive cytostatic chemotherapy and developed septic, antibiotic-resistant temperatures during severe treatment-induced neutropenia. During neutropenia hepatic and splenic foci were not identified by imaging procedures. Foci were poorly defined histologically. Blastospores and pseudomycelia were seen in non-reactive tissue and within necrotic areas in the liver, spleen, and other organs. Only Candida species could be isolated. One to four weeks after granulocyte recovery, round liver and splenic foci were demonstrated by sonographic and CT scans. Histologically, there were necrotic areas with blastospores and pseudohyphae exhibiting different degrees of cellular border reaction. Whereas the maximum diameter of fungal foci in aplasia was 0.4 cm, these increased in size to 1.5 cm after granulocyte regeneration.

Adolescent↗
PubMed1989

A double-blind clinical trial of fenticonazole (2%) spray versus naftifine (1%) spray in patients with cutaneous mycoses.

A multi-centre, double-blind trial was carried out in 100 patients with cutaneous mycotic infections, confirmed by direct microscopy and/or culture, to compare the efficacy and tolerability of spray formulations of 2% fenticonazole and 1% naftifine. On entry, patients were allocated at random to receive once daily topical applications of one or other drug over a period of 2 to 4 weeks, treatment being stopped when patients had recovered or substantially improved. Clinical and mycological assessments were made before (baseline), at weekly intervals during treatment and, if possible, 2 to 3 weeks after the end of treatment (drug-free period). Treatment was continued for 19.25 days with fenticonazole and 19.62 days with naftifine. All patients had positive mycological findings on entry. The most frequently isolated pathogens were dermatophytes, mainly Trichophyton rubrum; however, Candida albicans was present in 33.3% of patients in the fenticonazole group and in 20.8% of those treated with naftifine. At the end of treatment, only 3 (6.3%) and 5 (10.4%) patients, respectively, of the 48 patients assessed in each group still had positive mycological findings. Assessments of symptoms indicated comparable, significant improvement in both groups, and at the end of treatment the overall opinion of doctors and patients was that about 90% of patients were cured or greatly improved. The end of the drug-free period evaluation showed that, of the patients assessed as cured or greatly improved at the end of treatment, only 1 (3.2%) patient who had received fenticonazole and 2 (6.3%) who had received naftifine were confirmed mycologically as having relapsed.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1989

[Selective flora suppression for control of infection in surgical intensive care medicine].

The question to be answered in this study was: Is prophylactic selective florasuppression advantageous compared to conventional antibiotic policy as far as microbial colonisation, infection, mortality and development of resistance are concerned? A prospective, consecutive, placebo-controlled study in two ICU's was carried out during four 6-months periods. 200 patients who were intubated for at least 3 days, required intensive care for a minimum of 5 days, and belonged to either class III or IV according to the "Therapeutic Intervention Scoring System" were included in the study. They received either placebo or the prophylaxis regimen described by Stoutenbeek et al., consisting of polymyxin E, tobramycin and amphotericin B. Oropharyngeal, tracheobronchial and rectal colonisation with aerobic gram-negative bacilli markedly decreased in the test groups. The rates of nosocomial bronchopulmonary infections (ICU I and II) and urinary tract infections (ICU II) were significantly reduced. There was no significant reduction in wound infection, septicaemia and mortality rates. No development of resistance and no increase of multi-resistant strains occurred. Selective florasuppression is effective in reducing infection rates in critically ill patients without development of resistant strains.

Adult↗
PubMed1988

[Bronchoscopic diagnosis of lung infiltrates in immunocompromised patients].

Bronchoscopy with bronchoalveolar lavage was undertaken in 21 immunocompromised patients for microbiological and cytological diagnosis. In all of these patients radiologically confirmed pneumonic lesions had developed which, under empirical antibiotic treatment, had progressed or not clearly regressed. In four patients each the causative organisms of the pneumonia were identified as Pneumocystis carinii and Legionella, respectively, and Aspergilla in a further three. Proof of the causative organism in these patients resulted in a change of the antibiotic treatment. The pneumonia was healed in 11 patients. Ten patients died. Early bronchoscopy to identify the causative organism is recommended in immunocompromised patients so that, by administering microorganism-specific treatment, the at present high mortality in this group may be reduced.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Clinical course and risk factors in patients with generalized mycoses].

A retrospective analysis of the clinical course of disseminated fungal infections in 32 patients revealed 25 cases of candidiasis, 5 patients with aspergillosis, and 2 with mixed fungal infections. All patients had undergone cytostatic therapy for malignant hematological diseases as the predisposing risk factor for fungal infection. 30 patients had severe granulocytopenia (less than 500/cmm). In addition, 30 patients had received broad spectrum antibiotics and 16 had been treated with corticosteroids. 17 of 32 patients were treated systemically with antimycotic drugs for proven fungal infection. No antimycotic agents were given to 15 patients because fungal infections were diagnosed only on post mortem examination. 19 patients succumbed to overwhelming disease, including 5 in spite of antimycotic therapy. Patients in whom systemic candidiasis was detected after recovery of granulocytopoeisis had a better prognosis than patients who developed systemic fungal infections during the period of ongoing severe granulocytopenia.

Adult↗
PubMed1988

Resistance-pattern-analysis--a step toward predictable differentiated antibiotic therapy.

The Resistance-Pattern-Analysis (RPA)-the procedure will be described- makes possible a comparison of susceptibility test results of different antibiotics independent of patient and test related factors. Using two examples, the comparative assessment of a more recent antibiotic with well-tried older antibiotics and the selection of antibiotics for an interventive therapy, whereby the pathogen being unknown the therapy is based upon the probable pathogen, the expected susceptibility and the localization of the infection the practicability will be illustrated. A RPA of 1526 bacterial isolates was carried out using aztreonam, gentamicin and amikacin. Aztreonam was superior to amikacin against all species tested. In comparison to gentamicin, aztreonam showed the best results against Pseudomonadaceae. Using common combinations of antibiotics for the initial interventive therapy the possible use of RPA for a cost-risk-analysis from a medical microbiological viewpoint will be demonstrated.

Amikacin↗
PubMed1988

[Pneumopyopericardium--a rare complication following surgical correction of an "upside-down stomach"].

The follow-up period after surgery of an upside-down stomach in a 53-year-old patient was complicated by a pneumopyopericardium due to Candida albicans and Enterococcus. Therapy was performed by pericardial drainage. Local instillations of Mezlocillin (100 mg/l) and Amphotericin B (1 mg/l, Candida-MIC = 0.1 mg/l), over a period of 10 days and followed by a systemic antimycosis with 5-Flucytosin (0.14 g/d/kg over 5 days) and Amphotericin B (0.3 mg/d/kg over 11 days) led to recovery. Six months after discharge from the hospital, echocardiography revealed only a thickened pericardium without hemodynamic disorders.

Candidiasis↗
PubMed1986

Lysostaphin-based assay of human granulocyte functions: a reevaluation.

Lysostaphin, a staphylococcus-derived staphylocidal substance, has widely been used in assays of granulocyte phagocytic and bactericidal capability. It rapidly kills extracellular bacteria. Thus, a separate determination of intracellular surviving bacteria can be performed. One prerequisite for this approach is the safe inactivation of lysostaphin (usually brought about by trypsin) before the intracellular bacteria are externalized for plating. This inactivation has been found by others to be incomplete. Data are presented demonstrating a safe inactivation of lysostaphin by trypsin, if the pH value is maintained within the alkaline range. A low variation of results is obtained by plotting the total number of bacteria killed per incubate vs the logarithm of initial bacterial inoculum or of the intracellular surviving bacteria, leading to linear regression lines. The variation of the results increases greatly for initial bacteria/granulocyte proportions of greater than 5/1. The results obtained for two different St. aureus strains are significantly different. Dexamethasone pretreatment (12 mg p.o. within 8 h) had no detectable influence, when fresh blood was assayed, while blood storage at room temperature for 12 h (without dexamethasone pretreatment) led to a significant functional impairment, mainly of bactericidal capability when analyzed in a pairwise fashion. A major limitation of this kind of assays is that killed bacteria cannot be determined directly.

Bacteriological Techniques↗
PubMed1984

[Candida albicans endophthalmitis. Results of pars plana vitrectomy without intraocular antimycotic therapy].

An early pars plana vitrectomy was performed without any additional intravitreal antimycotic therapy in 8 eyes of 5 patients with candida endophthalmitis; anatomic healing with a good functional result was obtained. The good prognosis of vitrectomy without intravitreal antimycotic therapy in our patients is seen in (1) a total surgical extraction of the abscess and (2) the better intraocular ventilation obtained for endogenous resistance.

Adult↗
PubMed1984

[Current status of determining bacteria and resistance in urinary tract infections].

A total of 5.584 bacterial strains of different species from urine samples of various University clinics were isolated in 1983. These were tested with regard to their susceptability towards antibacterial substances. E. coli was the most common rod bacteria isolated, followed by Proteus species, Klebsiella und Pseudomonas. Staphylococci and Enterococci were found relatively frequently. A list was set up concerning the resistance pattern of the most important gram-negative rod bacteria toward four penicillin- and three cephalosporin derivatives as well as towards gentamicin and three chemotherapeutics in a stricter sense. For the first substance group mezlocillin supplied the best results. In the second group cefotaxime was most effective. More unfavorable on the whole were the results of the three chemotherapeutics. Enterococci were inhibited most by azlocillin, mezlocillin, ampicillin and nalidixic-acid. Cefsulodin as a special Pseudomonas cephalosporin showed strong activity towards this bacterial species.

Anti-Bacterial Agents↗
PubMed1979

[Experiences with an antimycotic tampon in the treatment of saccharomycetic vaginal infection].

Antimycotic (miconazole) medicated tampons were used for treatment in 53 patients with vaginal saccharomycetic infections as evidenced by hanging drop and on culture. A short term 2 1/2 day treatment with 5 tampons showed a success rate of 92.5%. The fast relief of symptoms like discharge, itching and burning is an improvement of the medicated tampon treatment. The new medicated tampons are considered as improvement of local vaginal treatment.

Adolescent↗
PubMed1977

[Cultural and serologic examination for saccharomycetic infection in pregnant women (author's transl)].

Cultures from retrolingual, vaginal, and anal smears were used to determine the presence of saccharomycetic infection in 177 pregnant women. The retrolingual smear was saccharomyces-positive in 29.1% of the cases; the vaginal smear, in 18.1%; the anal smear, in 7.3%. The fungus differentiation revealed the pathogen Candida albicans 85 times and the pathogen Candida krusei, 1 time. The Candida HA Test and the Candida JF Test (Roche) were carried out in 160 of the patients. A relationship could be determined between the clinical findings and the serologic results. The danger to the newborn when the mother has a saccharomycetic infection as well as the fundamentals for therapy were discussed.

Anus Diseases↗