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PubMed1988

Variation in adhesion and cell surface hydrophobicity in Candida albicans white and opaque phenotypes.

A previous study had established that a select group of pathogenic isolates of Candida albicans was capable of switching heritably, reversibly and at a high frequency (10(-2) to 10(-3)) between two phenotypes ('white' or 'opaque') readily distinguishable by the size, shape, and color of colonies formed on agar at 25 degrees C. This paper describes experiments designed to determine the ability of these two phenotypes to attach to buccal epithelial cells (BECs) and plastic, and to compare the cell surface hydrophobicities of white and opaque phenotypes from three clinical isolates. 'White cells' were found to be significantly more adhesive to BECs, and a strong correlation was also found between phenotype adhesiveness and the percentage of BECs to which C. albicans had attached. The percentage of BECs with one or more attached C. albicans was approximately 90% for the white phenotype and approximately 50% for the opaque phenotype. 'Opaque cells', in contrast, were twice as hydrophobic as white cells, and the percentage of opaque cells bound to BECs by coadhesion was also double that of white cells. The differences in adhesion to plastic between the two phenotypes were not statistically significant and there was no distinct trend to suggest which phenotype might be more adhesive to plastic. These results indicate that several factors are involved in the adhesion of C. albicans to plastic, and confirm the hypothesis that cell surface hydrophobicity is of minor importance in direct adhesion to epithelial cells but that it may contribute to indirect attachment to epithelial cells by promoting yeast coadhesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Candida albicans↗

PubMed1978

Erythromycin succinate in the treatment of acute exacerbations of chronic bronchitis.

In 20 patients with an acute exacerbation of chronic respiratory tract infection the effectiveness of oral erythromicin succinate 3 X 500 mg daily has been tested. The duration of treatment was 10 days in all cases. The criteria of success, in addition to the clinical findings, were the results of bacteriological investigations and assessment of the appearance of the sputum. In all patients sputum and serum concentrations or erythromicin were determined. All pathogens isolated from the sputum of the patients were erythromicin-sensitive. One instance of development of resistance was observed. The drug was well tolerated.

Adult↗

PubMed1983

Pharmacokinetics and clinical effects of cefuroxime in patients with severe renal insufficiency.

The pharmacokinetics and clinical effects of cefuroxime were investigated in 5 patients with severe impairment of renal function (creatinine clearance less than or equal to 23 ml/min), suffering from an urinary tract infection. Bolus i.v. injections of cefuroxime 750 mg b.i.d. or 750 mg once daily were given to the patients depending on the degree of renal impairment. The concentration of drug in serum and urine was measured during treatment, and pharmacokinetic parameters were evaluated on the second and last days; the parameters obtained on the 2 days did not differ significantly. Drug elimination half-life increased from 4.2 h (creatinine clearance 23.0 ml/min) to 22.3 h (creatinine clearance 5.0 ml/min) with decreasing renal function. The apparent volume of distribution ranged from 11.6 to 17.9 l, and showed a substantial increase to 29.6 l in the patient with the poorest renal function. A linear correlation was found between the total and renal clearance of cefuroxime and the creatinine clearance; the extrarenal clearance was 8.24 ml/min. Concomitant treatment with furosemide did not impair renal function and no evidence of nephrotoxicity was found. The clinical efficacy of the drug was good. Symptoms of infection subsided after 3-4 days and the isolated pathogens were eradicated. No relapse or episodes of reinfection were observed in a following-up period of 3 months. The drug was well tolerated and no side effects or changes in haematological or biochemical values were seen.

Aged↗

PubMed1984

Neonatal osteomyelitis in Nigerian infants.

Twenty-seven Nigerian infants with osteomyelitis during the first 28 days of life are presented to highlight the severity of the clinical manifestations and the radiological features of this infection. The clinical signs include limitation of movement of the extremities involved and localized swelling. Severe constitutional changes such as fever (greater than 39 degrees C) and abdominal distension were common. This contrasts with results from North America and Europe which emphasize the paucity of clinical signs despite involvement of multiple sites. Multiple site involvement was encountered in only eight cases. Staphylococcus aureus, proteus mirabilis and candida albicans were the main pathogens isolated. The long bones were more frequently affected. Aggressive bone destruction was a constant radiological finding peculiar to staphylococcal osteomyelitis while the formation of sequestrum, a rare occurrence in the newborn, was present in six patients. The mortality rate was 7.4% and the morbidity rate was equally low.

Arthritis, Infectious↗

PubMed1982

[Antibiotic concentrations in the abdominal cavity as basis for antibacterial therapy of peritonitis: penetration of mezlocillin into the peritoneal exudate].

The importance of the antibiotic concentration in peritoneal exudate is emphasized as a criterium for the possible success of antibiotic therapy of intra-abdominal infections. 5 g of mezlocillin were given i. v. over 15 min to ten patients with a mean age of 56 years. The serum concentrations, assayed microbiologically, were: 299.5 mg/l at the end of the infusion, 103.2 mg/l, 18.6 mg/l and 2.1 mg/l 60, 240 and 480 min after the end of the infusion, respectively. The serum half-life T1/2 beta, calculated from the beta phase, was 67 min. In the peritoneal fluid the peak concentration of Cp = 42.0 mg/l was achieved after 2.2 h. A quarter of this concentration was maintained in the peritoneal cavity for five to six hours. This concentration inhibited 74% of the 322 pathogens isolated from 123 intra-abdominal infections.

Ascitic Fluid↗

PubMed1977

Infectious complications of burns casualties during the Yom-Kippur War.

During the October 1973 military conflict, 41 burned patients hospitalized at the Sheba Medical Center were closely followed up. All the patients who had burns occupying 20% or more of the body surface developed wound infections. Pseudomonas aeruginosa was the major pathogen isolated. Most infections occurred during the second week following the injury. Serial cultures revealed that only the isolation of Proteus species and P. aeruginosa from wounds could predict an infection caused by those microorganisms. During treatment with gentamicin and carbenicillin a marked increase in carbenicillin-resistant P. aeruginosa and gentamicin-resistant Klebsiella strains was noted. Cross-infections with carbenicillin-resistant P. aeruginosa was not a major cause in the development of resistant strains.

Bacterial Infections↗

PubMed1979

[Legionnaires' disease in Germany (author's transl)].

In February 1979 a 51 year old man fell will in Munich, displaying symptoms of an influenza-like illness which developed into pneumonia. The patient died eight days later of circulatory collapse which failed to respond to treatment, accompanied by high temperature, leucopenia and agranulocytosis. Typical rods detected in the lung tissue and histological sections by immunofluorescence indicated the possibility of a Legionella pneumophila infection. The pathogen isolated from the lung tissue on CYE agar was identified as L. pneumophila, serogroup I. The diagnosis was confirmed by the CDC, Atlanta. This is the first time this organism has been isolated in Central Europe from a case with a fatal outcome.

Germany, West↗

PubMed1989

[Bronchopulmonary penetration of enoxacin].

We analysed enoxacin concentrations in plasma, saliva, bronchial secretions, bronchoalveolar lavage fluid, and alveolar macrophages in nine patients five hours after the last dose (400 mg enoxacin b.i.d. per os for at least three days). The enoxacin levels in the alveolar film were extrapolated from the lavage content by using urea as an internal marker (lavage dilution factor = plasma/lavage urea concentration ratio). The concentration in the alveolar film amounted to 7.62 mg/l ( = 381% of the plasma value), on average, and exceeded the minimal inhibitory concentrations of the pathogens isolated from the patients. Thus, enoxacin is effectively concentrated in the surface film of the lung which represents an important barrier against pulmonary infections.

Bronchoalveolar Lavage Fluid↗

PubMed1987

[Pseudomonas immunoglobulin prophylaxis in patients with burn injuries].

Pseudomonas aeruginosa belongs to the most frequent pathogens isolated from patients with burns. In a mouse model for artificial burns it was found that prophylactic administration of a hyperimmune globulin with antibody titres against P. aeruginosa (Fisher immunotypes 1, 2, 4 and 6) reduced mortality. Therefore, the prophylactic administration of Pseudomonas immunoglobulin was examined in a prospective randomized study in two groups of 13 patients each. Severely burned patients with at least second degree burns over 30% to 70% of the total body surface area received 250 mg Pseudomonas immunoglobulin/kg body weight by the intravenous route between days 3 and 13. After treatment, plasma IgG levels were significantly raised between days 7 and 16 as compared to the controls, yet the incidence of infections caused by P. aeruginosa was not reduced. However, only two of the six infected patients, developed septicaemia, whereas in the control group, local Pseudomonas infection led to septicaemia in five out of seven patients. The number of septicaemic Staphylococcus aureus infections was also lower in patients on immunoglobulin prophylaxis, with two cases compared to four cases in the control group. Due to the limited number of cases studied, statistically significant results could not be obtained, however, there was a positive trend in favour of Pseudomonas immunoglobulin treatment.

Adolescent↗

PubMed1985

Bone and joint infections caused by gram-positive bacteria: treatment with cefotaxime.

Cefotaxime treatment was evaluated in 41 patients with serious bone and joint infections. Septic arthritis and bursitis (8), acute and chronic osteomyelitis (33) were treated with 3 to 12 g of cefotaxime per day for three to 52 days. The diagnosis of osteomyelitis or septic arthritis was made on the basis of clinical and roentgenographic evidence of infection. The diagnosis of a joint infection was confirmed by a positive culture of a joint aspirate sample. The diagnosis of a bone infection was confirmed by either a positive culture of a bone biopsy or of blood in combination with a positive bone scan or roentgenogram. Staphylococcus aureus was the most frequently isolated pathogen. Overall, 36 of 41 patients, who met all criteria for evaluation, had satisfactory responses to cefotaxime. The drug was well tolerated by all patients. However, six patients had a direct Coomb's test, two patients were noted to be neutropenic and two patients developed a macular rash. It is concluded that cefotaxime is a useful and safe antibiotic for the treatment of osteomyelitis and septic arthritis.

Adolescent↗

PubMed1990

[Treatment results using cefixime for bacterial respiratory tract infections].

In a prospective open clinical trial 20 patients with the diagnosis bacterial respiratory tract infection and underlying chronic obstructive lung disease were treated for 13 to 17 days with 200 mg cefixime b. i. d. 14 of 16 evaluable patients were treated successfully. In one patient the clinical symptoms remained unchanged and in another patient cefixime treatment failed. Ten of the 16 evaluable patients showed a positive baseline culture. In nine of these patients the initially isolated pathogens could be eliminated. In one patient, in whom cefixime therapy failed, change of pathogens was noticed after the end of treatment. Four of the 20 patients treated with cefixime reported side effects (gastritis, three; fungal dermatitis, one). In the patient with fungal dermatitis cefixime therapy was stopped.

Adult↗

PubMed1990

[Clinical experiences with cefixime in the treatment of bacterial infections of the lower respiratory tract].

In a prospective, open clinical trial 21 patients suffering from lower respiratory tract infections were treated with the new oral cephalosporin cefixime. The antibiotic was given at a dosage of 200 mg b. i. d. for seven to eleven days. Seventeen of 18 evaluable patients were cured or distinctly improved at the end of therapy as well as two days after the end of treatment. Clinical results correlated well with the results of the lung function tests, especially with the significant decrease of resistance. At the end of therapy all initially isolated pathogens were eradicated. The tolerability of cefixime was good, only in two patients treated mild and transient side effects were noticed (1 x diarrhea, 1 x epigastric pain).

Adult↗

PubMed1991

Interpretive criteria of antimicrobial disk susceptibility tests with flomoxef.

320 recently isolated pathogens, 20 strains from each of 16 species, were investigated using Mueller-Hinton agar and DIN as well as NCCLS standards. The geometric mean of the agar dilution MICs of flomoxef were 0.44 mg/l for Staphylococcus aureus, 0.05 mg/l (Klebsiella oxytoca) to 12.6 mg/l (Enterobacter spp.) for enterobacteriaceae, 33.1 mg/l for Acinetobacter anitratus, 64 mg/l for Enterococcus faecalis, and more than 256 mg/l for Pseudomonas aeruginosa. For disk susceptibility testing of flomoxef a 30 micrograms disk loading and the following interpretation of inhibition zones using the DIN method were recommended: resistant-up to 22 mm (corresponding to MICs of 8 mg/l or more), moderately susceptible-23 to 29 mm (corresponding to MICs from 1 to 4 mg/l), and susceptible-30 mm or more (corresponding to MICs of 0.5 mg/l or less). The respective values for the NCCLS method using the American high MIC breakpoints are: resistant--up to 14 mm (corresponding to MICs of 32 mg/l or more), moderately susceptible--15 to 17 mm (corresponding to MICs of 16 mg/l), and susceptible--18 mm or more (corresponding to MICs of 8 mg/l or less).

Cephalosporins↗

PubMedDate not supplied

[Prevention using a Pseudomonas immunoglobulin in burn patients].

Adolescent↗

PubMedDate not supplied

Secondary mycosis in surgery: treatment with fluconazole.

Together with the severity of the underlying disease, mycotic infections are assuming increasing significance in surgical patients under intensive care. 26 patients with severe internal mycotic infections were treated with fluconazole in an open clinical trial. The pathogens isolated were Candida albicans in 22 cases, Candida tropicalis in four, Torulopsis glabrata in three, Candida parapsilosis in two and Aspergillus fumigatus in one. Mixed infections were found in five cases. Most of this series of surgical patients had a severe, life-threatening post-operative condition. Their mean classification by the Apache score was 15.35. The most frequent risk factors were previous injuries to intraabdominal hollow organs and extensive antibiotic therapy; and the peritoneum was, therefore, the commonest site of infection. Antimycotic therapy was with fluconazole at a dose of 200-400 mg daily for at least ten days. The mycosis was cured in 22 of the 26 patients, one of these being a case of severe mycotic peritonitis. Nine patients died of the underlying disease within four weeks of the beginning of treatment. Fluconazole was effective and well tolerated in the treatment of severe life-threatening infections in surgical patients.

Adult↗

PubMed1986

[Imipenem/cilastatin in surgical intensive medicine].

26 patients from the surgical intensive care unit, University Hospital Lübeck, received imipenem/cilastatin for severe abdominal, respiratory or urogenital infections. 500 mg imipenem/cilastatin were infused i.v. over 30 min q. i. d. The treatment was successful in 84,6% of the patients suffering from severe infections. Two cases were considered to be failures. 36 of the 43 isolated pathogens (83.7%) were eliminated. Transitory elevations of liver enzymes were the most frequent side-reactions observed; an increase in serum creatinine, diarrhoea or fungal colonization were less common.

Abdomen↗

PubMed1979

[Experience with cefaclor in the treatment of ear, nose and throat infections. Indications for cefaclor therapy (author's transl)].

The efficacy and tolerance of the new oral cephalosporin cefaclor was tested in 61 patients treated for a variety of moderate to severe ENT infections which were not expected to undergo a spontaneous remission without antibacterial therapy. The most frequently isolated pathogens were streptococci and Staphylococcus aureus. The dosage consisted of 500 mg cefaclor three times daily, and the treatment lasted between 4 and 43 days (average 14 days). In 35 cases, some of whom had already been treated unsuccussfully with another antibiotic, the results were very good. In 22 patients locally applied medicaments or surgery contributed to the good result. In four patients an unequivocal evaluation was not possible or therapy was not successful. The frequently noted rapid response to treatment with cefaclor was impressive. No relapses were recorded. In pharmacokinetic studies a cefaclor concentration of 2.8 mcg/g was obtained in the tonsils 90 minutes after oral administration of 1000 mg. Clinical examinations in 61 patients and a complete range of laboratory tests in 47 patients did not reveal any case of allergic reaction. One patient only complained of nausea and diarrhoea. In two patients temporary low grade thrombopenia and thrombocytosis respectively were observed. In several patients a slight transitory rise in transaminases was seen. Cefaclor thus proved to be an effective and well-tolerated antibiotic. Its indications in the treatment of ENT infections are discussed.

Adolescent↗

PubMed1996

Prospective study of 288 episodes of bacteremia in neutropenic cancer patients in a single institution.

Trends in causative organisms and sources of infection were studied in a series of 288 episodes of bacteremia in neutropenic cancer patients observed in a single institution from 1986 to 1993. The incidence of bacteremia increased significantly from 20 episodes per 1000 admissions in 1986 to 50 episodes per 1000 admissions in 1993 (p = 0.00001). Over the study period, a continuous increment in gram-positive bacteremia, which reached 81% of episodes in 1993 (p = 0.000001), was observed. Conversely, the incidence of gram-negative bacteremia remained stable. Coagulase-negative staphylococci and viridans group streptococci were the most commonly isolated pathogens. Bacteremia caused by coagulase-negative staphylococci increased from 3 episodes per 1000 admissions to 19 episodes per 1000 admissions (p = 0.0001), and viridans group streptococci bacteremia increased from 0 episodes per 1000 admissions to 19 episodes per 1000 admissions (p = 0.000001). The upward trend in gram-positive bacteremia appeared to be related to a significant increase in both intravascular catheters (p = 0.003) and oral mucositis (p = 0.003) as sources of infection. Specific strategies to prevent chemotherapy-induced mucositis and catheter-related bacteremia merit further investigations.

Adolescent↗