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At least 613 records · Page 34Linked to original sources
PubMed1975

[Urologic complications in rectal surgery (author's transl)].

Urinary disorders after amputation or resection of the rectum are much more frequent than commonly supposed. Out of 239 patients they were noticed by 56.6%, undergoing amputation, and 36.6% after resection. Longterm disturbances were observed by 26.4% respect. 15.1%. The most important reason is injury of autonomic pelvic nerves and ganglia. Urinary bladder infection was verified in 22% respect. 8%. Furthermore urinary disorders may be caused by changing of bladder localization (bladder hernia), wound infection (especially of the sacral cavity), edema of the urethra, and exacerbation or manifestation of pre-existing urologic diseases. Compared to these, lesions of the urinary tract are of little importance. To prevent such complications, we postulate: 1. careful pre-operative urologic examination, 2. if possible mobilisation of the rectum along its borderlines (so-called Grenzlamellen of Pernkopf), 3. critical analysis of urologic disorders, removal of the urinary catheter as soon as possible, regular systemic prophylaxis of urinary infection, and therapy controlled by antibiogram, 4. adequate follow-up, and 5. urologic examination of all disturbances lasting longer than three months.

Age Factors↗
PubMed1997

Percutaneous lumbar discectomy in the treatment of lumbar discitis.

Lumbar disc infection, either after surgical discectomy or caused by haematogenous spread from other infection sources, is a severe complication. Specific antibiotic treatment has to be started as soon as possible to obtain satisfactory results in conservative treatment or operative fusion. The aim of this study was to analyse 16 cases of lumbar disc infection, treated with percutaneous lumbar discectomy (PLD) to obtain adequate amounts of tissue for histological examination and microbial culture. Between 1990 and 1994, 26 patients with vertebral osteomyelitis were treated. Sixteen patients, with an average age of 41.4 years (range 14-59 years), underwent a diagnostic PLD. Eight of them showed only moderate changes on computed tomograms (CT scans) and magnetic resonance (MR) images in the initial stages of the disease. The other eight showed more or less extensive osteolytic lesions of one or both vertebral bodies adjacent to the involved disc. The histology results showed non-specific discitis in nine patients and tuberculosis in one. In two patients an open biopsy had been performed, which showed non-specific discitis. Microbiological analysis revealed specific infection in 45% of the patients. These patients received a specific antibiotic treatment after antibiogram for an average of 33 days. Only three patients were treated surgically, with evacuation of the disc space and interbody fusion; the whole group received a spondylitis brace. All patients obtained satisfactory clinical results at the last follow-up regarding pain, mobility and spontaneous fusion of the involved disc space. In conclusion, PLD is a very helpful minimally invasive procedure in conservative treatment of lumbar discitis.

Adult↗
PubMed1995

Fluorescence-based DNA fingerprinting elucidates nosocomial transmission of phenotypically variable Pseudomonas aeruginosa in intensive care units.

DNA fingerprinting based on automated laser fluorescence analysis of randomly amplified polymorphic DNA (RAPD-ALFA) is a rapid and convenient technique for detecting clonal relatedness of bacterial isolates of nosocomial concern. During an outbreak of Pseudomonas aeruginosa among five patients in a medical intensive care unit, transmission was not suspected because of the phenotypic variability of the initial isolates. However, DNA fingerprinting by RAPD-ALFA and macrorestriction analysis identified a single genotype (strain A) for isolates from three patients and another genotype (strain B) for isolates from the remaining two patients. Strain A isolates displayed three phenotypes defined by different antibiotypes and distinct colony appearance. Retrospective analysis of DNA fingerprints demonstrated that strain A had been transmitted to the index patient one year previously in a different intensive care unit. The study demonstrates that genetic typing approaches are warranted should epidemiological relatedness be identified between phenotypically variant pathogens. Automated laser fluorescence analysis of PCR fingerprints may facilitate routine screening of bacterial isolates for in-house epidemiological surveillance. Antibiograms are an unsuitable approach for the typing of Pseudomonas aeruginosa.

Adult↗
PubMed1977

Correlation of minimum inhibitory concentration and beta-lactamase activity.

The beta-lactamase activity of 510 recently isolated Enterobacteriaceae was investigated with a quantitative photometric test. Beta-lactamase could be detected in 55 percent of the Enterobacteriaceae. At the same time minimal inhibition concentration (MIC) of beta-lactam antibiotics was determined. There was no correlation between MIC values and lactamase activity. For correct antibacterial therapy the clinician requires information on the lactamase activity of isolated bacteria in addition to the antibiogram. The qualitative test is useful for screening.

Amidohydrolases↗
PubMed1998

Endarteritis and mycotic aortic aneurysm caused by an oral strain of Actinobacillus actinomycetemcomitans.

Actinobacillus actinomycetemcomitans was isolated from blood cultures of a 33-year-old febrile patient with a previously undiagnosed coarctation of the aorta. Subgingival samples from diseased periodontal pockets revealed the presence of A. actinomycetemcomitans. An infected (mycotic) aortic aneurysm and endarteritis were diagnosed and surgically treated. The identity of blood and oral clinical isolates of A. actinomycetemcomitans was supported by genetic analysis, including fingerprinting by restriction fragment length polymorphism, ribotyping, and random amplified polymorphic DNA; biotyping; and antibiogram typing. These data strongly suggest that the periodontal pockets were the primary source of A. actinomycetemcomitans endarteritis in this case.

Actinobacillus Infections↗
PubMed1996

Analysis of the prevaccine population of noncapsulate Haemophilus influenzae and identification of a putative epidemic clone.

For six months prior to the introduction of Haemophilus influenzae serotype b vaccines, all noncapsulate Haemophilus influenzae received by our laboratory were characterised by biotyping, antibiogram, outer-membrane protein profiling, and ribotyping. Simpson's index of diversity (SID) showed the population was heterogeneous with multiple clones. The study identified a clone within noncapsulate Haemophilus influenzae biotype II that caused more disease than other strains. This clone was shown to have previously caused two outbreaks of respiratory disease and to possess a small extrachromosomal plasmid encoding ampicillin resistance. The study shows that describing the diversity within a bacterial population with SID may negate the need for retrospective subtyping comparisons.

Anti-Bacterial Agents↗
PubMedDate not supplied

Dose-dependent rate of nosocomial pulmonary infection in mechanically ventilated patients with brain oedema receiving barbiturates: a prospective case study.

In a prospective case study we investigated whether the application of barbiturates in artificially ventilated patients with brain oedema has dose-dependent effects on the rate of nosocomial pneumonia. Pneumonia developed within the first seven days of controlled ventilation in patients receiving barbiturates; furthermore, the rate of nosocomial pneumonia was significantly higher in patients receiving barbiturates than in the control group without barbiturates (7.7%; p less than 0.0181); thus a clear dose dependency was shown (high-dose group: 43.8%, low-dose group: 21.4%). In all patients with pneumonia, colonization of the respiratory tract with pathogenic organisms preceded the pulmonary infection by four days. Under barbiturate therapy colonization of the respiratory tract occurred in all patients and one or two days earlier than in the control group, in which only 70% of the patients were colonized. These differences were significant for each of the first six days after hospitalization (p less than 0.0001-0.013). While in the high-dose group both colonization and pneumonia were caused mainly by gram-positive pathogens, mixed gram-positive and gram-negative pathogens were isolated in groups 2 and 3. Thus the higher rate of pneumonia of 43.8% in the high-dose group suggests a need for regular and semiquantitative monitoring of the causative agents and their antibiogram. Such measures could lead to early recognition with high predictability of the development of nosocomial pneumonia in colonized patients, allowing for timely application of the most appropriate antibiotics.

Adolescent↗
PubMed1994

Antibiotic treatment of burned patients: an Italian multicentre study.

Antibiotic therapy in burn centres with highly specialized ICUs has reduced the mortality and morbidity in burn and trauma but, in spite of constantly improving supportive surgical and resuscitation methods, infection remains a major problem. Indeed, the clinical experience, as recorded in Europe and the USA, using different antimicrobial drugs and regimens, emphasizes a constantly evolving pattern of pathogenic microorganisms in the wound and in the rest of the patient's body, and their increasing chemoresistance. We report the preliminary results of 559 patients in a large controlled multicentre clinical study (mean age 41.4 +/- 17.8 years and burns covering a mean body surface area of 35.7%), with the collaboration of 13 of the 15 major Italian burn centres. The antibiotic treatment consisted of prophylactic administration of pefloxacin (800 mg i.v. OD for 4 days) for all patients as a first treatment while waiting for an antibiogram, and chemotherapy with teicoplanin (800 mg i.v. OD) together with netilmicin (300 mg i.m. OD) in one or more cycles. At random, half of the patients received thymostimulin (70 mg i.m. OD pro die for the first month and every other day thereafter until discharge from hospital). Of the bacterial pathogens involved in septic complications, 63.3% were Gram-positive (Staphylococcus spp. and Streptococcus spp.). The mortality rate was 15.5%. Pefloxacin chemoprophylaxis was successful in 19.4% of patients and cure or improvement was seen with combination chemotherapy in 66.7% of patients, mainly with only one treatment cycle. The incidence of mortality and sepsis was not significantly influenced by treatment with thymostimulin.

Adolescent↗
PubMed1995

Differentiation of strains from a food-borne outbreak of Salmonella enterica by phenotypic and genetic typing methods.

A combination of typing methods was used to identify the strains and the infection source in a food-borne outbreak of Salmonella enterica occurring in a summer camp and affecting 25 children. All isolates tested were found to be serovar Enteritidis, with an identical biotype API 20E and ribotype. However, they differed in their plasmid profiles and/or antibiograms, and were grouped into three strains. One strain was found in human stools, another in a hen's egg, and the third in both stools and another egg pointing to large Spanish omelettes to be the contaminated food source.

Bacterial Typing Techniques↗
PubMed1993

Trimethoprim resistance in South African isolates of aerobic gram-negative faecal flora.

Aerobic gram-negative commensal faecal flora from 362 healthy volunteers was examined for resistance to trimethoprim. Three hundred fifty-seven trimethoprim-resistant organisms were isolated from 272 of the volunteers (297 Escherichia coli, 46 Klebsiella spp., 9 Enterobacter spp. and 7 other species). Trimethoprim resistance was associated with resistance to other antibiotics at the following frequencies: ampicillin 71.4%, tetracycline 88%, cephalosporins 14% and aminoglycosides 4%. High-level resistance to trimethoprim (MIC > or = 1024 mg/l) occurred in 98.6% of the isolates. Trimethoprim resistance was transferable in 51.2% of the isolates. An X+ factor was required to mobilize resistance in a further 3.4%. Resistance to other antibiotics cotransferred with trimethoprim at the following frequencies: ampicillin 55.4%, tetracycline 30%, cephalosporins 1.5% and aminoglycosides 2.6%. Restriction enzyme analysis of 148 plasmids revealed 79 different profiles. Two restriction profiles represented 10.1 and 8.8% of these plasmids, respectively. The large number of different antibiograms and restriction profiles indicates that there is a large gene pool of trimethoprim-resistant organisms in the faecal flora.

Bacteria, Aerobic↗
PubMed1985

Evaluation of the Cobasbact automated antimicrobial susceptibility testing system.

The Cobasbact is an automated system for use in the microbiological laboratory which is capable of performing antimicrobial susceptibility tests within five hours. The performance of the Cobasbact system was evaluated using 2000 non-fastidious, facultative and aerobic clinical bacterial isolates. The standard Kirby-Bauer disk diffusion test served as reference method. For gram-positive isolates, the rate of overall full and essential agreement between Cobasbact and reference antibiograms was 90% and 95.5% respectively, for Enterobacteriaceae 91% and 95.5% and for Pseudomonas spp. 90% and 96%. Reproducibility studies yielded an essential agreement rate of 98%. On the basis of this preliminary evaluation it would seem that the Cobasbact system can rapidly produce reasonably accurate and reproducible results of antimicrobial susceptibility tests for gram-positive cocci, Enterobacteriaceae and Pseudomonas spp.

Automation↗
PubMed1982

Evaluation of the MS-2 automated antimicrobial susceptibility testing system: report of a European collaborative study.

The MS-2 is an instrument for rapid automated testing of antimicrobial susceptibility. Its performance was evaluated by comparison with disc diffusion and MIC tests in a collaborative study in four European laboratories. Tests on independently isolated organisms showed the MS-2 to be in essential agreement with conventional methods in 94.8% of tests. A further series of 170 well-defined pathogens for which a reference antibiogram was available were tested by MS-2 and the manual methods in all of the participating laboratories. MS-2 results were in full accord in 90% of tests and in essential agreement in 94%. MS-2 results compared at least as well with the reference values as did either of the manual methods. Initial problems of false susceptibility results with erythromycin and penicillin were resolved by (1) the addition of small amounts of erythromycin which acted as an inducer and (2) by the use of a low content penicillin disc. MS-2 was found to be reliable and needed no attention following loading of the test cuvette cartridges. A print-out of the results was available 2-5 h after inception of the test.

Anti-Bacterial Agents↗
PubMed1983

ABAC identibiogramme: prototype of an automated system for identification of enterobacteria.

The ABAC Identibiogramme, an automated, computerized system for the identification and antimicrobial susceptibility testing of the Enterobacteriaceae has been developed recently. The biological basis of the system resides in lyophilized, highly discriminating media enclosed in wells of an automatically inoculated disposable cartridge. The introduction of a suitable specimen rehydrates and inoculates the media in the wells. After incubation for 16 to 18 h at 37 degrees C and the addition of only one reagent (Kovacs reagent), the media changes and the results obtained are interpreted by an automated optical system and a computer. The antibiogram is also used by the computer to confirm the biochemical identification of the organism. The identification accuracy of a prototype of the ABAC Identibiogramme system was compared with that of API 20 E and conventional methods using a total of 1,290 clinical isolates. The ABAC Identibiogramme correctly identified 96.8% of the organisms tested, misidentified 2.4% and failed to identify 0.8%. The results demonstrate the high reliability and good identification performance of the ABAC Identibiogramme in comparison to API 20 E and conventional methods.

Enterobacteriaceae↗
PubMed1997

Comparison of traditional and molecular methods for typing nontoxigenic strains of Corynebacterium diphtheriae.

Thirty-eight nontoxigenic strains of Corynebacterium diphtheriae isolated between 1987 and 1992 from clinical specimens of French patients were typed by biotyping, antibiograms, bacteriophage typing, ribotyping, and restriction analysis by pulsed-field gel electrophoresis (PFGE). Excellent correlation occurred between the genotypes defined by PFGE SfiI profiles or by ribotype BstEII profiles. Genotyping revealed seven genotype patterns among the 26 biotype mitis isolates, five among the nine biotype gravis isolates, and three among the three biotype belfanti isolates. Phage typing was nonreactive for nine of the 38 isolates. A combination of all the typing methods led to the identification of 19 different types of Corynebacterium diphtheriae.

Anti-Bacterial Agents↗
PubMedDate not supplied

Subverting bacterial resistance using high dose, low solubility antibiotics in fibrin.

Antibiotics (ABs) delivered from fibrin were evaluated for control of multi-drug resistant (MDR) Staphylococcus aureus. ABs having low aqueous solubility (< or = 1 mg/ml) were encapsulated by fibrin (composed of fibrinogen, thrombin, Factor XIIIa and calcium chloride) and examined. Electron microscopy revealed fibrin-caged, tetracycline crystals that were 0.26 to 2.8 microns in size and bound within the reticular matrix. Antibiograms documented that S. aureus ATCC 27659 was resistant to erythromycin (ERY), penicillin G (PEN), streptomycin (STR), sulfamethoxazole-trimethoprim (SXT) and tetracycline (TET). However, low solubility formulations of STR (10 mg/ml) or SXT (0.5 mg/ml), delivered from fibrin and evaluated by the agar disk diffusion assay, produced zones of growth inhibition after 18-24 h at 37 degrees C in vitro, indicating renewed susceptibility of S. aureus ATCC 27659 to these ABs. ERY, PEN and TET were unable to overcome resistance at concentrations up to 10 mg/ml. In vivo, intraperitoneal (i.p.) injection of 150 mg/kg STR delivered from fibrin resulted in 100% survival of rats with MDR S. aureus peritonitis as compared with control rats receiving i.p. STR (150 mg/kg) in 0.9% saline. The results demonstrate that some low solubility ABs delivered from fibrin are efficacious in controlling infection mediated by MDR S. aureus.

Animals↗
PubMed2000

Stethoscopes and nosocomial infection.

Stethoscopes are an essential tool of the medical profession and can become a source of nosocomial infection. A study conducted in the Department of Pediatrics, Kasturba Medical College and Hospital showed a high carriage of methicillin resistant staphylococcus (69.76%) and multi-drug resistant Gram negative bacilli (20.93%) on regularly used stethoscopes. The antibiogram of the bacterial isolates strongly suggested these to be nosocomial strains. A verbal survey revealed that regular cleaning is not common among doctors. A policy regarding cleaning of stethoscopes with an effective disinfectant may be helpful in reducing hospital-associated infections.

Child↗
PubMedDate not supplied

An outbreak of multidrug resistant typhoid fever in Bangalore.

Six hundred and eighty five blood cultures from children clinically diagnosed as enteric fever yielded 176 salmonella strains showing isolation success rate of 25.7%, S. typhi were 164 (93.2%), S. paratyphi A 5 (2.8%), S. choleraesuis 4 (2.3%) and S. typhimurium 3 (1.7%). Antibiogram of 164 isolates of S. typhi showed triple drug resistance (TDR) in 156 strains (95.1%) to chloramphenicol, ampicillin and cotrimoxazole, and sensitivity of 90.2% and 95.1% to norfloxacin and ciprofloxacin respectively. Minimum inhibitory concentrations (MIC) of chloramphenicol were between 360 mcg and 640 mcg per ml. Phage types of 38 strains of TDR S. typhi were predominantly E1 and 0 with prevalences of 47.4% and 36.8% respectively in this region. All children with S. typhi isolates sensitive to quinolones in Vitro responded well to these drugs with almost no relapse and hence, the newer generation of quinolones could be considered as the first choice in the primary treatment of enteric fever.

Anti-Bacterial Agents↗
PubMed1998

Outbreak of nosocomial Acinetobacter baumannii bacteremia in a high risk ward.

Acinetobacter baumannii is emerging as a major cause of nosocomial infections particularly in high risk patients. Being resistant to adverse environmental conditions, it can stay for prolonged periods in the hospital environment. We report an outbreak in the medical oncology ward where nine patients suspected of bacteraemia were blood culture positive for A. baumannii from the two samples each, one collected through the i.v. cannula and another through the peripheral veneous puncture. The bacteria was also isolated from the environmental sources from the various samples collected. The biotype, antibiogram, cellular protein profiles on SDS-PAGE and the restriction enzyme analysis patterns of the patient isolates and the environmental isolates were similar. This points to the environment as a source of infection. With reinforcement of proper barrier nursing and use of disposable heparine ampoules it was possible to control the outbreak.

Acinetobacter Infections↗