Effective Antimicrobial Treatment Research Articles

Risk Factors forStaphylococcus aureusNosocomial Pneumonia in Critically III Patients

Staphylococcus aureus nosocomial pneumonia has become an important infection not only because of an apparently increasing incidence but also because of its high mortality rate. A total of 50 episodes of nosocomial pneumonia in critically ill patients in which etiologic diagnosis was well established were prospectively followed in a medical-surgical intensive care unit (ICU). S. aureus was isolated in a total of 13 episodes. In the univariate analysis the variables significantly associated with S. aureus nosocomial pneumonia were below 25 yr of age, coma, nonuse of corticosteroids, and antecedent trauma. A step-forward logistic regression analysis defined only coma as significantly influencing the risk of developing S. aureus nosocomial pneumonia. We suggest that antimicrobial drugs active against S. aureus must be included in the initial empirical antimicrobial regimen for treating nosocomial pneumonia in patients with coma. The identification of factors influencing the etiology and the possibility of earlier effective antimicrobial treatment may represent a further step in the control of nosocomial pneumonia in critically ill patients by improving its prognosis.

Multiple drug resistance in salmonellae in England and Wales: a comparison between 1981 and 1988.

Each year from 1981 through to 1988 the most common serotypes isolated from man in England and Wales and identified at the Division of Enteric Pathogens were S typhimurium, S enteritidis, and S virchow. In 1981 these three serotypes accounted for 45%, 12%, and 7% of isolations. The remaining 35% comprised strains belonging to a further 188 different serotypes, none of which accounted for more than 1% of the total. In 1988 S typhimurium accounted for 24% of isolations, S enteritidis 57%, and S virchow 4%. The remaining 15% comprised strains of a further 184 serotypes. The resistances to the common antimicrobial drugs in non-typhoidal salmonellas isolated in England and Wales in 1981 and 1988 were reported with particular reference to resistance to four or more antimicrobial drugs (multiple resistance). For S typhimurium the overall percentage of resistant strains varied little, but multiple resistance more than doubled from 5% to 12%; in S enteritidis the incidence remained the same. In S virchow the percentages of strains resistant to all the antimicrobial drugs and in particular, to chloramphenicol, streptomycin, trimethoprim and furazolidone, rose from 0.2% to 10.4%. Salmonella enteritis in man is usually a self limiting disease and antimicrobial treatment is seldom required; but should spread beyond the intestine occur, effective antimicrobial treatment is essential. Under these circumstances a knowledge of the likelihood of resistances to commonly available drugs could be of considerable value to the clinician.

Microbiology, Chemotherapy and Mortality of Brain Abscess in Newcastle-upon-Tyne between 1979 and 1988

71 patients admitted to Newcastle Regional Neurosurgical Centre between 1979 and 1988 with a diagnosis of brain abscess are reviewed. The overall mortality was 9.9%, with an operative mortality of 7%. The bacteriology of these abscesses is discussed in detail, together with the importance of effective standardized antimicrobial treatment regimens. The low mortality figures appeared to be in direct relationship to early recognition of this condition, prompt surgical intervention and effective chemotherapy.

Chronic prostatitis: comments on infectious etiologies and antimicrobial treatment.

Twenty-three males with the clinical diagnosis of chronic prostatitis were evaluated for a bacterial etiology by the Stamey and Meares method. In addition, 16 patients, regardless of culture results, were placed on either cefadroxil or oral carbenicillin antimicrobial therapy. Culture results identified only four (17%) of 23 patients with bacterial prostatitis: coagulase-negative Staphylococcus (2), Enterobacter agglomerans (1), and Haemophilus parainfluenzae, and coagulase-negative Staphylococcus (1). Four of seven patients who received oral carbenicillin and three of nine patients who received cefadroxil reported symptomatic relief. This study did not identify a common etiology for chronic prostatitis or a consistently effective antimicrobial treatment. Rather, we observed that the etiologic agent in most cases of chronic prostatitis (83%) could not be identified by routine bacteriologic culture. Future research efforts in chronic prostatitis must address not only treatment regimens but expand the search for etiologic agents.

Pneumococcal Infections

THE PNEUMOCOCCUS (<i>Streptococcus pneumoniae</i>) remains a major cause of pneumonia, meningitis, and otitis media in the United States and in other parts of the world. Pneumococcal infection represents an important medical problem, not only because of its common occurrence, but also because too many deaths still occur from these serious infections despite the availability of effective antimicrobial drug treatment. Although case fatality rates in bacteremic pneumonia and meningitis have decreased markedly in the antibiotic era compared with those of the preantibiotic era, they remain unexpectedly high. This review aims to define the incidence and clinical significance of pneumococcal pneumonia and other pneumococcal infections in the US population and to identify those groups of persons who seem at highest risk for morbidity and mortality. Although pneumococcal infections occur commonly, their precise incidence is not known.^1,2Epidemiologic studies aimed at establishing the incidence of pneumococcal infection in differing populations have been

Fulminating fatal pneumonia due to blastomycosis.

A 48-year-old American Indian manifested an acute fulminating pneumonia involving the entire left lung and the right midlung and died within a fortnight of his illness. Too late for effective antimicrobial treatment, yeast-cell forms were identified in sputum stained with methenamine silver. Severe bilateral pneumonia from Blastomyces dermatitidis was confirmed at autopsy, and sputum and pleural fluid yielded the fungus.

The role of acute lower respiratory infection in causing pulmonary insufficiency in bronchiectasis.

Excerpt Although effective antimicrobial treatment has reduced the prevalence of fulminating infections in patients with bronchiectasis, repeated and protracted episodes of acute lower respiratory ...

Setting Up the Full Denture; Producing a Balanced Articulation

We studied the clinical presentation and microbiology of patients with deep neck space infection in a developing nation to aid in determining the relevant, appropriate, and effective empirical antimicrobial treatment. We have also described the demographic data of pediatric versus adult patients and the predominant age-related subtypes of deep neck space infections.A retrospective review of the data from patients with deep neck space infections during a 5.5-year period was conducted at the academic teaching hospitals in Johannesburg, South Africa. The diagnosis of deep neck space infection was determined from the clinical, radiographic, and laboratory findings. All the patients had undergone abscess drainage via needle aspiration or surgical drainage using a sterile technique. Aerobic and anaerobic bacterial cultures and cultures for Mycobacterium tuberculosis were performed. The results were recorded, and statistical analysis was performed.A total of 107 children and 52 adults with deep neck space infections were included in the present study, with 121 and 70 pus specimens retrieved. The male/female ratio was 1.14:1 for the pediatric group (57 boys [53%] and 50 girls [47%]). The adult group included 33 men (63%) and 19 women (37%). The male/female ratio for the adult group was 1.74:1. In the pediatric group, the mean age was 5.8 years (range, 2 months to 15 years). The age distribution was subcategorized into younger than 2, 2 to 10, and older than 10 years. Of the 107 children, 51 were younger than 2, 50 were aged 2 to 10, and 6 were older than 10 years. The age of the adult patients ranged from 19 to 77 years (mean, 40.9 ± 15.5). Multispace involvement of the deep neck infection was present in 8 pediatric cases (7.5%) and 31 adult cases (59.6%). The submandibular space was the most commonly affected site (73.9%) in both groups.Deep neck space infections differ in clinical presentation and microbiology between adults and children. The specimens from the pediatric group predominantly cultured Staphylococcus aureus. In contrast, the specimens from the adult group were mainly polymicrobial. The adult population had poorer patient outcomes, with a greater number of intensive care unit admissions, operating theater visits, and prolonged hospital stays.